MEDICARE: CARLOS RESURRECCION CARN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	470554	NY

General Provider Information

NPI Number	:	1528712288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS RESURRECCION CARN

Provider Business Mailing Address
First Line	:	57 LINCOLN AVE
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-2519
Country	:	US
Telephone Number	:	201-244-9730
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 W 125TH ST FL 6
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4439
Country	:	US
Telephone Number	:	212-636-4848
Fax Number	:	212-866-5741

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	11/02/2023

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Directions to “ CARLOS RESURRECCION CARN” Practice Location

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