Provider Demographics
NPI:1124423322
Name:CARUSO, MICHAEL (LPN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CARUSO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 DENNIS DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9630
Mailing Address - Country:US
Mailing Address - Phone:609-652-3691
Mailing Address - Fax:609-652-3691
Practice Address - Street 1:421 DENNIS DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9630
Practice Address - Country:US
Practice Address - Phone:609-652-3691
Practice Address - Fax:609-652-3691
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06118600164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse