Provider Demographics
NPI:1538460498
Name:CADOO, LISA K (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:K
Last Name:CADOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 PARK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2988
Mailing Address - Country:US
Mailing Address - Phone:973-577-3010
Mailing Address - Fax:973-577-3011
Practice Address - Street 1:66 PARK ST STE 100
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2988
Practice Address - Country:US
Practice Address - Phone:973-577-3010
Practice Address - Fax:973-577-3011
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31816207R00000X
NJ25MA09608400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0482790Medicaid
AL511-29174OtherBC AND BS OF AL
NJHORIZONOtherBLUECROSS
NJUHCOtherUNITED HEALTHCARE
AL141495Medicaid
NJBCBSOtherBLUE CROSS BLUE SHIELD
NJCIGNAOtherCIGNA