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General NPI Number Information
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NPI Number | 1578931929
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Entity Type | Organization
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Legal Business Name | DICARRE NEW JERSEY LLC
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 125 HALF MILE RD SUITE 200
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City | RED BANK
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State | NJ
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Zip | 07701-6749
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Country | US
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Telephone | 732-337-6492
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Fax |
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Provider Business Mailing Address
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Address Line | 125 HALF MILE RD SUITE 200
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City | RED BANK
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State | NJ
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Zip | 07701-6749
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Country | US
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Telephone | 732-337-6492
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Fax |
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Authorized Official
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Title or Position | COO
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Name | DR. HUMBERTO FONG
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Credential | DPT
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Telephone | 732-337-6492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1959684
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License Number State | NJ
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