NPIMap

Organization Active NPI

Cadoo Medical PC

  • Internal Medicine Physician
  • Montclair, NJ
National Provider Identifier
1528626488
Registry record updated Nov 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CADOO MEDICAL PC
Practice address
66 Park St
Montclair, NJ 07042-5908
Phone
(973) 577-3010
Fax
(973) 577-3011
NPI assigned
Jun 4, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Lisa Cadoo, MD
Title
President
Phone
(973) 577-3010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

66 Park St
Montclair, NJ 07042-5908

Mailing address

66 Park Street
Suite 100
Montclair, NJ 07042
Phone (973) 577-3010

Other identifiers 5

IdentifierTypeStateIssuer
1538460498OtherNPI
BCBSOtherNJHORIZON
CIGNAOtherNJCIGNA
CLOVEROtherNJCLOVER
UHCOtherNJUNITEDHEALTHCARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nherrera@cadoomedical.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191028002589 NJ Part B Supplier - Clinic/Group Practice 1052643830 Receives reassigned benefits from 5 practitioners
Practice locations: Montclair, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2171716Cadoo Medical, PC66 Park Street, Montclair, NJ 07042Certificate of waiverSep 8, 2027

National Provider Directory

National Provider Directory

Locations

66 Park St
Ste 100
Montclair, NJ 07042
Phone (973) 433-6162

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605225600000",
    "number": "1528626488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 PARK STREET",
            "address_2": "SUITE 100",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "07042",
            "telephone_number": "973-577-3010",
            "fax_number": "973-577-3011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 PARK ST",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070425908",
            "telephone_number": "973-577-3010",
            "fax_number": "973-577-3011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CADOO MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-04",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A",
        "authorized_official_last_name": "CADOO",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-577-3010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1538460498",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON",
            "identifier": "BCBS",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "CIGNA",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLOVER",
            "identifier": "CLOVER",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE",
            "identifier": "UHC",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nherrera@cadoomedical.com",
            "affiliation": "N",
            "address_1": "66 Park St",
            "city": "Montclair",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "070425908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Montclair, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.