Basic Information
| Provider Information | |||||||||
| NPI: | 1023351079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACK | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ADEGITE | ||||||||
| OtherFirstName: | CAROLINE | ||||||||
| OtherMiddleName: | O | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1149 ONE GUSTATVE PLACE | ||||||||
| Address2: | MT SINAI MEDICAL CENTER DEPT OF EMERGENCY MEDICINE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100290311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128248069 | ||||||||
| FaxNumber: | 2122411279 | ||||||||
| Practice Location | |||||||||
| Address1: | PEDIATRIC EMERGENCY DEPARTMENT | ||||||||
| Address2: | 30 PROSPECT AVE | ||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076010760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5519962000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2013 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PP0204X | 25MA10612900 | NJ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine |
No ID Information.