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General NPI Number Information
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NPI Number | 1134645211
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Entity Type | Individual
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Provider Name | CARLYE MARISSA BIANCO PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/20/2017
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Last Update Date | 08/20/2017
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Provider Practice Location Address
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Address Line | 6 GREENWICH OFFICE PARK
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City | GREENWICH
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State | CT
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Zip | 06831-5151
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Country | US
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Telephone | 203-485-8735
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Fax |
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Provider Business Mailing Address
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Address Line | 13 CAROLYN CT
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City | EATONTOWN
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State | NJ
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Zip | 07724-1365
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Country | US
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Telephone | 908-596-0320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3928
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License Number State | CT
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