Healthcare Provider Details

I. General information

NPI: 1821618711
Provider Name (Legal Business Name): JAMILTON B CARLON CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CLARA MAASS DR
BELLEVILLE NJ
07109-3550
US

IV. Provider business mailing address

4 DONALD ST APT B
BLOOMFIELD NJ
07003-6110
US

V. Phone/Fax

Practice location:
  • Phone: 973-450-2000
  • Fax:
Mailing address:
  • Phone: 973-337-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number43ZA00505600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: