Provider Demographics
NPI:1194876789
Name:CARTER, GRETCHEN HAYNES (DPM)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:HAYNES
Last Name:CARTER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07051-0337
Mailing Address - Country:US
Mailing Address - Phone:908-486-9091
Mailing Address - Fax:908-634-1000
Practice Address - Street 1:1200 ROSELLE ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-2529
Practice Address - Country:US
Practice Address - Phone:973-485-6799
Practice Address - Fax:973-485-6711
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD0024110213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223620546OtherBLUE CROSS/BLUE SHIELD
NJ777006Medicaid
145525OtherCHN
480025921OtherRAILROAD MEDICARE
NJ777006Medicaid