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General NPI Number Information
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NPI Number | 1366827313
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Entity Type | Organization
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Legal Business Name | MARY DAISY CANTEY MD CAROLINA MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 312 S ORANGE AVE
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2502
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Country | US
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Telephone | 973-532-7898
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Fax | 973-821-5999
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Provider Business Mailing Address
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Address Line | 312 S ORANGE AVE
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2502
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Country | US
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Telephone | 973-532-7898
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Fax | 973-821-5999
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARY DAISY CANTEY
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Credential | MD
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Telephone | 973-532-7898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA07425300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA07425300
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License Number State | NJ
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