Healthcare Provider Details

I. General information

NPI: 1639598782
Provider Name (Legal Business Name): CAROLYN AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 QUEEN ANN CT
LONG VALLEY NJ
07853-3641
US

IV. Provider business mailing address

5 QUEEN ANN CT
LONG VALLEY NJ
07853-3641
US

V. Phone/Fax

Practice location:
  • Phone: 862-219-8786
  • Fax:
Mailing address:
  • Phone: 862-219-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NO11707300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: