Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DI013793 | NJ |
NPI | 1093734014 |
---|---|
Provider Name | Dr. Frank Carotenuto |
First Address | Roselle Park, NJ 07204-1903 |
Second Address | Roselle Park, NJ 07204-1903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 22/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128649 | (02) | NJ |