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Individual

DR. KENNETH LEE CACCAVALE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
39 JANE ST, SUITE #1E, NEW YORK, NY 10014-5106
(212) 243-9085
(212) 243-9085
Mailing address
39 JANE ST, SUITE #1E, NEW YORK, NY 10014-5106
(212) 243-9085
(212) 243-9085

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
116401-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00215518
NY
Enumeration date
08/20/2007
Last updated
08/20/2007
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