Healthcare Provider Details

I. General information

NPI: 1295554533
Provider Name (Legal Business Name): CARDINE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 ROUTE 70
LAKEWOOD NJ
08701-5949
US

IV. Provider business mailing address

160 JAMES ST BLDG 4-12
TOMS RIVER NJ
08753-5571
US

V. Phone/Fax

Practice location:
  • Phone: 732-370-0444
  • Fax:
Mailing address:
  • Phone: 914-564-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26NP49590000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: