| Drc360, Llc | |
|
29 South St New Providence NJ 07974-2934 | |
| (973) 452-9078 | |
| Not Available |
| Full Name | Drc360, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 29 South St, New Providence, New Jersey |
| Authorized Official Name and Position | Anthony Richard Cavazos (OWNER) |
| Authorized Official Contact | 9734529078 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Drc360, Llc 29 South St New Providence NJ 07974-2934 Ph: (973) 452-9078 | Drc360, Llc 29 South St New Providence NJ 07974-2934 Ph: (973) 452-9078 |
| NPI Number | 1679964795 |
|---|---|
| Provider Enumeration Date | 02/11/2015 |
| Last Update Date | 02/11/2015 |
| Medicare PECOS PAC ID | 6608196712 |
|---|---|
| Medicare Enrollment ID | O20150513000725 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679964795 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Zina B Cappiello |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1134121734 PECOS PAC ID: 6406843523 Enrollment ID: I20040429000419 |
| Provider Name | Anthony Cavazos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104944263 PECOS PAC ID: 0143316109 Enrollment ID: I20071022000776 |
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