Healthcare Provider Details

I. General information

NPI: 1194876789
Provider Name (Legal Business Name): GRETCHEN HAYNES CARTER D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ROSELLE ST
LINDEN NJ
07036-2529
US

IV. Provider business mailing address

PO BOX 337
ORANGE NJ
07051-0337
US

V. Phone/Fax

Practice location:
  • Phone: 973-485-6799
  • Fax: 973-485-6711
Mailing address:
  • Phone: 908-486-9091
  • Fax: 908-634-1000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number25MD0024110
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: