Provider Demographics
NPI:1154538759
Name:CANGEMI, CARLA PRIMIANI (MD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:PRIMIANI
Last Name:CANGEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1942
Mailing Address - Country:US
Mailing Address - Phone:732-258-7065
Mailing Address - Fax:732-258-7213
Practice Address - Street 1:200 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1942
Practice Address - Country:US
Practice Address - Phone:732-258-7065
Practice Address - Fax:732-258-7213
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO79761002080P0203X
NY2344622080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0223042Medicaid
NJ176717B7AMedicare PIN