Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 25MD0024110 | NJ |
NPI | 1194876789 |
---|---|
Provider Name | Dr. Gretchen Haynes Carter |
First Address | Orange, NJ 07051-0337 |
Second Address | Linden, NJ 07036-2529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 25/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
145525 | CHN (01) | |
223620546 | BLUE CROSS/BLUE SHIELD (01) | NJ |
480025921 | RAILROAD MEDICARE (01) | |
777006 | (05) | NJ |
CA000778 | (02) | NJ |