Healthcare Provider Details

I. General information

NPI: 1356084354
Provider Name (Legal Business Name): HANNA YOO CARRASCO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 BAY AVE STE 102
GLEN RIDGE NJ
07028-1621
US

IV. Provider business mailing address

311 BAY AVE STE 102
GLEN RIDGE NJ
07028-1621
US

V. Phone/Fax

Practice location:
  • Phone: 973-798-4777
  • Fax: 973-748-8755
Mailing address:
  • Phone: 973-798-4777
  • Fax: 973-748-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB12828700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: