Healthcare Provider Details

I. General information

NPI: 1295438489
Provider Name (Legal Business Name): JASON JORGE CARVALHO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S SEACREST BLVD
BOYNTON BEACH FL
33435-7969
US

IV. Provider business mailing address

198 EAGLE ST
NORTH ARLINGTON NJ
07031-5819
US

V. Phone/Fax

Practice location:
  • Phone: 561-733-5933
  • Fax: 866-617-8268
Mailing address:
  • Phone: 973-525-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: