Provider Demographics
NPI:1104670645
Name:CARFAGNO, JACK (DO)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:CARFAGNO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E LAUREL ROAD, ADMIN OFFICE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084
Mailing Address - Country:US
Mailing Address - Phone:856-651-8682
Mailing Address - Fax:
Practice Address - Street 1:18 E LAUREL RD, ADMIN OFFICE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084
Practice Address - Country:US
Practice Address - Phone:856-651-8682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0000000000000207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery