Provider Demographics
NPI:1336341197
Name:DICARLO, FREDERICK JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JOSEPH
Last Name:DICARLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6245
Mailing Address - Country:US
Mailing Address - Phone:908-222-7977
Mailing Address - Fax:908-756-8025
Practice Address - Street 1:1460 LIVINGSTON AVE
Practice Address - Street 2:BUILDING NO 800
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1873
Practice Address - Country:US
Practice Address - Phone:173-264-5319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA47522174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist