Healthcare Provider Details

I. General information

NPI: 1912900671
Provider Name (Legal Business Name): CARL ANTHONY KIRTON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

40 PERSHING RD
CLIFTON NJ
07013-2632
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-3921
  • Fax: 212-241-4556
Mailing address:
  • Phone: 973-773-9572
  • Fax: 973-773-9572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF301588
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: