Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00387400 | NJ |
N | 111NR0200X | Radiology | 38MC00387400 | NJ |
N | 213ER0200X | Radiology | 38MC00387400 | NJ |
NPI | 1114948759 |
---|---|
Provider Name | Dr. Charles A Carabasi |
First Address | Marlton, NJ 08053-2157 |
Second Address | Marlton, NJ 08053-2157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 25/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
223159415 | TAX ID (01) | NJ |
650483YMD5 | (02) | NJ |