Provider Demographics
NPI:1033388525
Name:CARL M. INGRASSIA
Entity Type:Organization
Organization Name:CARL M. INGRASSIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:M
Authorized Official - Last Name:INGRASSIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-738-4441
Mailing Address - Street 1:519 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-2131
Mailing Address - Country:US
Mailing Address - Phone:732-738-4441
Mailing Address - Fax:732-738-8554
Practice Address - Street 1:519 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-2131
Practice Address - Country:US
Practice Address - Phone:732-738-4441
Practice Address - Fax:732-738-8554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6192505Medicaid
NJ4324890001Medicare NSC
NJ6192505Medicaid