Healthcare Provider Details

I. General information

NPI: 1578633921
Provider Name (Legal Business Name): CARLOTTA HAMPLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ RM 200
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

LIJMC - PEDIATRIC GASTROENTEROLOGY 269-01 76TH AVENUE
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2001
  • Fax:
Mailing address:
  • Phone: 718-470-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number207819
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number25MA09782200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: