1952392623 NPI number — DR. DAVID CAROTENUTO O.D.

Table of content: DR. DAVID CAROTENUTO O.D. (NPI 1952392623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952392623 NPI number — DR. DAVID CAROTENUTO O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAROTENUTO
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

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:
1952392623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 ROUTE 34
Provider Second Line Business Mailing Address:
STE. 515
Provider Business Mailing Address City Name:
COLTS NECK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07722-2520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-409-0100
Provider Business Mailing Address Fax Number:
732-409-1024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 ROUTE 34
Provider Second Line Business Practice Location Address:
STE. 515
Provider Business Practice Location Address City Name:
COLTS NECK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07722-2520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-409-0100
Provider Business Practice Location Address Fax Number:
732-409-1024
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  27OA00485900 , 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: 8562202 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2521883 . This is a "PXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2588237 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1K8448 . This is a "HEALTH NET- GUARDIAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2117729 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5305010 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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