Healthcare Provider Details

I. General information

NPI: 1932219573
Provider Name (Legal Business Name): PETER CARIDE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9226 KENNEDY BLVD SUITE A
NORTH BERGEN NJ
07047-5312
US

IV. Provider business mailing address

9226 KENNEDY BLVD SUITE A
NORTH BERGEN NJ
07047-5312
US

V. Phone/Fax

Practice location:
  • Phone: 201-869-9500
  • Fax: 201-869-9501
Mailing address:
  • Phone: 201-869-9500
  • Fax: 201-869-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA06275200
License Number StateNJ

VIII. Authorized Official

Name: PETER CARIDE
Title or Position: OWNER
Credential: MD
Phone: 201-869-9500