Healthcare Provider Details

I. General information

NPI: 1730366295
Provider Name (Legal Business Name): DR. EDWARD JAMES CAROLAN II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 VALLEY RD
CLARK NJ
07066-1811
US

IV. Provider business mailing address

141 VALLEY RD
CLARK NJ
07066-1811
US

V. Phone/Fax

Practice location:
  • Phone: 732-499-9464
  • Fax: 732-499-9464
Mailing address:
  • Phone: 732-499-9464
  • Fax: 732-499-9464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI01666700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: