John Michael Carnevale, D.M.D.
Individual provider Active NPI Dentist · Northvale, NJ
NPI 1710068697 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1710068697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 22DI01033600 (NJ)
- Practice address
- 103 Paris Ave
Northvale, NJ 07647-1515 - Phone
- (201) 767-7676
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI01033600 | NJ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwoods Family Dentistry LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI01033600 | NJ | Yes |
Addresses
Primary practice location
103 Paris Ave
Northvale, NJ 07647-1515
Mailing address
445 Andre Ave
Northvale, NJ 07647-1326
Phone (201) 767-8885
Other providers in Northvale, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.