1346375714 NPI number — CARMEN C. CANLAS MD

Table of content: (NPI 1346375714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346375714 NPI number — CARMEN C. CANLAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARMEN C. CANLAS MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346375714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5B DOCTOR'S PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HACKETTSTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-852-8096
Provider Business Mailing Address Fax Number:
908-852-5012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5B DOCTOR'S PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACKETTSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-852-8096
Provider Business Practice Location Address Fax Number:
908-852-5012
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARPENTER
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
908-852-8096

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  25MA02856100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6190006 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1437150711 . This is a "TYPE I NPI NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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