1275639783 NPI number — RICARDO CARABALLO MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275639783 NPI number — RICARDO CARABALLO MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CARABALLO

Provider First Name:

RICARDO

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1275639783

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/25/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 416457

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BOSTON

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

02241-6457

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

973-656-6280

Provider Business Mailing Address Fax Number:

973-290-7495

Provider First Line Business Practice Location Address:

6012 MAIN STREET

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

VOORHEES

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08043

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

856-325-6622

Provider Business Practice Location Address Fax Number:

856-325-6522

Provider Enumeration Date:

09/15/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207V00000X , with the licence number:  25MA06319600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207VF0040X , with the licence number: NJMA63196 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2207042/7597015 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: P2704813 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 7780702 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 3K7732 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0094687000 . This is a "AMERIHEALTH/KEYSTONE/IBC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 010003742 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1105869 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1949172 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 24212 . This is a "UNIVERSITY HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 9402184 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".