Provider Demographics
NPI:1144752510
Name:CAVERY, LLC
Entity Type:Organization
Organization Name:CAVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:646-623-1020
Mailing Address - Street 1:3031 JASMINE CT
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-4701
Mailing Address - Country:US
Mailing Address - Phone:646-623-1020
Mailing Address - Fax:
Practice Address - Street 1:3031 JASMINE CT
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-4701
Practice Address - Country:US
Practice Address - Phone:646-623-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104534261QR0200X
CA2085N0700X261QR0200X
CA20855R0202X261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL200251220AMedicaid
FL179157001Medicaid
FL5H881Medicare PIN