Provider Demographics
NPI:1689616344
Name:LACAVERA, JOSEPH A III (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:LACAVERA
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:494 BARRETTS RUN RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3870
Mailing Address - Country:US
Mailing Address - Phone:856-455-7081
Mailing Address - Fax:856-935-2684
Practice Address - Street 1:348 GRANT ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-2108
Practice Address - Country:US
Practice Address - Phone:856-935-6120
Practice Address - Fax:856-935-2684
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB2901500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1328204Medicaid
NJ1328204Medicaid
NJLA451284Medicare PIN