Healthcare Provider Details

I. General information

NPI: 1366827313
Provider Name (Legal Business Name): MARY DAISY CANTEY MD CAROLINA MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 S ORANGE AVE
SOUTH ORANGE NJ
07079-2502
US

IV. Provider business mailing address

312 S ORANGE AVE
SOUTH ORANGE NJ
07079-2502
US

V. Phone/Fax

Practice location:
  • Phone: 973-532-7898
  • Fax: 973-821-5999
Mailing address:
  • Phone: 973-532-7898
  • Fax: 973-821-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07425300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07425300
License Number StateNJ

VIII. Authorized Official

Name: MS. MARY DAISY CANTEY
Title or Position: OWNER
Credential: MD
Phone: 973-532-7898