Provider Demographics
NPI:1134231889
Name:CACCIARELLI, ANDREA
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:CACCIARELLI
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:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-0032
Mailing Address - Country:US
Mailing Address - Phone:973-477-6476
Mailing Address - Fax:
Practice Address - Street 1:29 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3407
Practice Address - Country:US
Practice Address - Phone:973-364-0135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO65229208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG44918Medicare UPIN
NJAC764434Medicare PIN