Provider Demographics
NPI:1336692011
Name:CAVALLARO, DANIELA (NP)
Entity Type:Individual
Prefix:MS
First Name:DANIELA
Middle Name:
Last Name:CAVALLARO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:
Other - Last Name:KOFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1932
Mailing Address - Country:US
Mailing Address - Phone:201-447-1900
Mailing Address - Fax:
Practice Address - Street 1:330 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-447-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00649500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health