1891781183 NPI number — MARC S CARP PL

Table of content: (NPI 1891781183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891781183 NPI number — MARC S CARP PL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARC S CARP PL
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:
1891781183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848593
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:
02284-8593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-468-4180
Provider Business Mailing Address Fax Number:
305-595-1013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 NE MIAMI GARDENS DR
Provider Second Line Business Practice Location Address:
STE 221
Provider Business Practice Location Address City Name:
NORTH MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33179-4844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-949-2020
Provider Business Practice Location Address Fax Number:
305-949-6715
Provider Enumeration Date:
09/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CARP
Authorized Official First Name:
MARC
Authorized Official Middle Name:
S
Authorized Official Title or Position:
EMPLOYEE
Authorized Official Telephone Number:
305-949-2020

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0038332 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2499150 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00120815 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 22472 . This is a "WELLCARE/STAYWELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 049699500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3450134 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 95735 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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