Provider Demographics
NPI:1548389877
Name:THE CARDIO-THORACIC SURGICAL GROUP, PA
Entity Type:Organization
Organization Name:THE CARDIO-THORACIC SURGICAL GROUP, PA
Other - Org Name:THORACIC GROUP, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CACCAVALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-247-3002
Mailing Address - Street 1:35 CLYDE RD
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5033
Mailing Address - Country:US
Mailing Address - Phone:732-247-3002
Mailing Address - Fax:732-846-3819
Practice Address - Street 1:35 CLYDE RD
Practice Address - Street 2:SUITE # 104
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5033
Practice Address - Country:US
Practice Address - Phone:732-247-3002
Practice Address - Fax:732-846-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ208G00000X208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2615304Medicaid
NJ527148Medicare ID - Type Unspecified