Basic Information
| Provider Information | |||||||||
| NPI: | 1063596179 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAVALIERE | ||||||||
| FirstName: | AVA | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 617 | ||||||||
| Address2: | |||||||||
| City: | OCEAN VIEW | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082300617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096249003 | ||||||||
| FaxNumber: | 6096249002 | ||||||||
| Practice Location | |||||||||
| Address1: | 2041 N ROUTE 9 | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082101162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096521000 | ||||||||
| FaxNumber: | 6094418976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 12/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MB07105500 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | MB07105500 | NJ | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 8773505 | 05 | NJ | MEDICAID | 02362476 | 05 | NY | MEDICAID | 7954000 | 05 | MD | MEDICAID |