Basic Information
| Provider Information | |||||||||
| NPI: | 1821618711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLON | ||||||||
| FirstName: | JAMILTON | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | CRT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 DONALD ST APT B | ||||||||
| Address2: | |||||||||
| City: | BLOOMFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070036110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733377573 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 CLARA MAASS DR | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071093550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734502000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2020 | ||||||||
| LastUpdateDate: | 04/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227800000X | 43ZA00505600 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified |
No ID Information.