Provider Demographics
NPI:1720563778
Name:CAJUSTE, GRAVIANNA
Entity Type:Individual
Prefix:
First Name:GRAVIANNA
Middle Name:
Last Name:CAJUSTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204
Mailing Address - Country:US
Mailing Address - Phone:908-377-8512
Mailing Address - Fax:
Practice Address - Street 1:1 WOODSIDE RD
Practice Address - Street 2:B25
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-0720
Practice Address - Country:US
Practice Address - Phone:908-377-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)