Provider Demographics
NPI:1154485332
Name:SHREWSBURY VASCULAR AND GENERAL SURGERY ASSOCIATES LLC
Entity Type:Organization
Organization Name:SHREWSBURY VASCULAR AND GENERAL SURGERY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-747-4744
Mailing Address - Street 1:655 SHREWSBURY AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4179
Mailing Address - Country:US
Mailing Address - Phone:732-747-4744
Mailing Address - Fax:732-747-4751
Practice Address - Street 1:655 SHREWSBURY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4179
Practice Address - Country:US
Practice Address - Phone:732-747-4744
Practice Address - Fax:732-747-4751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41837208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1392000Medicaid
069353Medicare ID - Type Unspecified
NJ1392000Medicaid