Healthcare Provider Details

I. General information

NPI: 1275572034
Provider Name (Legal Business Name): MILINDA RUTH CARSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 PASSAIC AVE
PASSAIC NJ
07055-4717
US

IV. Provider business mailing address

203 PASSAIC AVE
PASSAIC NJ
07055-4717
US

V. Phone/Fax

Practice location:
  • Phone: 973-246-6999
  • Fax: 973-685-7340
Mailing address:
  • Phone: 973-246-6999
  • Fax: 973-685-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMA05970500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number281313
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6939902
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: