Provider Demographics
NPI:1083762173
Name:GOLDBLATT, CAROL JOAN I (RN, MS, APNC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JOAN
Last Name:GOLDBLATT
Suffix:I
Gender:F
Credentials:RN, MS, APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 JUPITOR ST
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-3018
Mailing Address - Country:US
Mailing Address - Phone:732-396-3149
Mailing Address - Fax:732-382-7209
Practice Address - Street 1:117-119 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060
Practice Address - Country:US
Practice Address - Phone:908-756-6870
Practice Address - Fax:908-756-5566
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC03900200364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6629806Medicaid
NJ6629806Medicaid
NJ672842Medicare ID - Type Unspecified