Healthcare Provider Details

I. General information

NPI: 1427053222
Provider Name (Legal Business Name): MICHAEL CARROLL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579A CRANBURY RD
EAST BRUNSWICK NJ
08816-5426
US

IV. Provider business mailing address

579A CRANBURY RD
EAST BRUNSWICK NJ
08816-5426
US

V. Phone/Fax

Practice location:
  • Phone: 732-390-0040
  • Fax: 732-390-1856
Mailing address:
  • Phone: 732-390-0040
  • Fax: 732-390-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA06187500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: