=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811471329
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLY CHIARELLA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2018
-----------------------------------------------------
Last Update Date | 12/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 ROUTE 23 STE 4
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07416-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-657-2800
-----------------------------------------------------
Fax | 973-814-4777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 406 ROUTE 23 STE 4
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07416-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-657-2800
-----------------------------------------------------
Fax | 973-814-4777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40QA01822200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------