Provider Demographics
NPI:1720355274
Name:MCCABE, CLEO BOSACCO
Entity Type:Individual
Prefix:
First Name:CLEO
Middle Name:BOSACCO
Last Name:MCCABE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLEO
Other - Middle Name:
Other - Last Name:BOSACCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2 MEETING HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1350
Mailing Address - Country:US
Mailing Address - Phone:609-457-8724
Mailing Address - Fax:
Practice Address - Street 1:2 MEETING HOUSE LN
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1350
Practice Address - Country:US
Practice Address - Phone:609-457-8724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07372700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine