Edward James Carolan II
Individual provider Active NPI Dentist · Clark, NJ
NPI 1730366295 · NPPES record last updated Jan 28, 2008
Key facts
- NPI
- 1730366295
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 22DI01666700 (NJ)
- Practice address
- 141 Valley Rd
Clark, NJ 07066-1811 - Phone
- (732) 499-9464
- Fax
- (732) 499-9464
- NPI assigned
- Jan 28, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 22DI01666700 | NJ | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI01666700 | NJ | Yes |
Addresses
Primary practice location
141 Valley Rd
Clark, NJ 07066-1811
Mailing address
141 Valley Rd
Clark, NJ 07066-1811
Phone (732) 499-9464
Other providers in Clark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2008. 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.