Healthcare Provider Details

I. General information

NPI: 1720743529
Provider Name (Legal Business Name): CARBON HEALTH PRIMARY CARE OF NEW JERSEY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4564 US HIGHWAY 9
HOWELL NJ
07731-3771
US

IV. Provider business mailing address

PO BOX 210
PORTSMOUTH NH
03802-0210
US

V. Phone/Fax

Practice location:
  • Phone: 732-366-3377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARLEY PAGE
Title or Position: DIRECTOR CONTRACTING & CREDENTIALIN
Credential:
Phone: 417-861-9739