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NPI Code Detail

MEDICARE: JACK CARLETON MD

MEDICARE: JACK CARLETON MD
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
1207R00000XInternal Medicine Physician128487NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811980873
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK CARLETON MD
Provider Business Mailing Address
First Line : 800 RED MILLS RD
Second Line :
City : WALLKILL
State : NY
Zip : 12589-3220
Country : US
Telephone Number : 845-744-9105
Fax Number : 845-744-9107
Provider Business Practice Location Address
First Line : 600 STONY BROOK CT
Second Line :
City : NEWBURGH
State : NY
Zip : 12550-6524
Country : US
Telephone Number : 845-391-8557
Fax Number : 845-608-8270
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2005
Last Update Date : 02/21/2022

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