Provider Demographics
NPI:1538353347
Name:IMELDA A. CARIN, MD, PA
Entity type:Organization
Organization Name:IMELDA A. CARIN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-299-1168
Mailing Address - Street 1:40 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-2807
Mailing Address - Country:US
Mailing Address - Phone:973-229-1168
Mailing Address - Fax:973-299-1355
Practice Address - Street 1:302 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7308
Practice Address - Country:US
Practice Address - Phone:718-384-0010
Practice Address - Fax:718-599-4632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149173-1261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00715182Medicaid
NY245246OtherHMO WELLCARE
NY60518589AOtherHMO FIDELIS CARE
NY60518589AOtherHMO FIDELIS CARE
NY76A481Medicare PIN
NY60518589AOtherHMO FIDELIS CARE