Healthcare Provider Details

I. General information

NPI: 1326654989
Provider Name (Legal Business Name): THOMAS PETER CARUSO JR. CPHT-ADV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 06/25/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

20 PROSPECT AVE
HACKENSACK NJ
07601-1997
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2000
  • Fax:
Mailing address:
  • Phone: 551-996-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number28RW03649200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier30122469
Identifier TypeOTHER
Identifier State
Identifier IssuerPTCB - ADVANCED CERTIFIED PHARMACY TECHNICIAN (CPHT-ADV)
# 2
Identifier30165265
Identifier TypeOTHER
Identifier State
Identifier IssuerPTCB - IMMUNIZATION ADMINISTRATION CERTIFICATE
# 3
Identifier28RJ09897
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerIMMUNIZATION REGISTRATION
# 4
Identifier30182717
Identifier TypeOTHER
Identifier State
Identifier IssuerPTCB - CONTROLLED SUBSTANCES DIVERSION PREVENTION CERTIFICATE
# 5
Identifier30146731
Identifier TypeOTHER
Identifier State
Identifier IssuerPTCB - BILLING AND REIMBURSEMENT CERTIFICATE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: