Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DI020747 | NJ |
NPI | 1417945767 |
---|---|
Provider Name | Dr. Vincent Carrao |
First Address | Fort Lee, NJ 07024-5471 |
Second Address | Fort Lee, NJ 07024-5471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 08/07/2007 |