Provider Demographics
NPI:1528147949
Name:CAROLLO, JOHN A (D M D P A)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:CAROLLO
Suffix:
Gender:M
Credentials:D M D P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 COLUMBIA TPKE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2181
Mailing Address - Country:US
Mailing Address - Phone:973-377-5117
Mailing Address - Fax:973-377-4942
Practice Address - Street 1:131 COLUMBIA TPKE
Practice Address - Street 2:SUITE 2A
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2181
Practice Address - Country:US
Practice Address - Phone:973-377-5117
Practice Address - Fax:973-377-4942
Is Sole Proprietor?:No
Enumeration Date:2006-11-05
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI1014671001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-2630009OtherFEDERAL TAX NUMBER