1538353347 NPI number — IMELDA A. CARIN, MD, PA

Table of content: (NPI 1538353347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538353347 NPI number — IMELDA A. CARIN, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMELDA A. CARIN, MD, PA
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:
1538353347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 RIVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE HIAWATHA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07034-2807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-229-1168
Provider Business Mailing Address Fax Number:
973-299-1355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11211-7308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-384-0010
Provider Business Practice Location Address Fax Number:
718-599-4632
Provider Enumeration Date:
09/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARIN
Authorized Official First Name:
IMELDA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-299-1168

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  149173-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00715182 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 245246 . This is a "HMO WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 60518589A . This is a "HMO FIDELIS CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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