Provider Demographics
NPI:1861674616
Name:CASADO, MAEVE GORDON (MSPT)
Entity Type:Individual
Prefix:MS
First Name:MAEVE
Middle Name:GORDON
Last Name:CASADO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FOREST GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1908
Mailing Address - Country:US
Mailing Address - Phone:848-391-2697
Mailing Address - Fax:
Practice Address - Street 1:760 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3224
Practice Address - Country:US
Practice Address - Phone:732-661-1121
Practice Address - Fax:732-661-1151
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01034600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ125766T8HOtherMEDICARE