Healthcare Provider Details

I. General information

NPI: 1326677899
Provider Name (Legal Business Name): CARTER MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 09/05/2021
Certification Date: 09/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E BROAD ST
GIBBSTOWN NJ
08027-2007
US

IV. Provider business mailing address

321 E BROAD ST
GIBBSTOWN NJ
08027-2007
US

V. Phone/Fax

Practice location:
  • Phone: 856-305-1600
  • Fax:
Mailing address:
  • Phone: 856-335-2288
  • Fax: 856-335-2267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY RENEE MACK
Title or Position: CEO, OWNER
Credential: APN
Phone: 856-305-1600