Individual
DR. LISA K. CADOO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
66 PARK ST STE 100, MONTCLAIR, NJ 07042-2988
(973) 577-3010
(973) 577-3011
Mailing address
66 PARK ST STE 100, MONTCLAIR, NJ 07042-2988
(973) 577-3010
(973) 577-3011
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA09608400
NJ
207R00000X
Internal Medicine Physician
31816
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0482790
—
NJ
05
—
141495
—
AL
01
—
511-29174
BC AND BS OF AL
AL
01
—
BCBS
BLUE CROSS BLUE SHIELD
NJ
01
—
CIGNA
CIGNA
NJ
01
—
HORIZON
BLUECROSS
NJ
01
—
UHC
UNITED HEALTHCARE
NJ
Enumeration date
11/09/2010
Last updated
11/13/2020
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