Provider Demographics
NPI:1083848022
Name:CARABALLO, JESUS M
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:M
Last Name:CARABALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 CONVERY BLVD
Mailing Address - Street 2:ROUTE 35 SOUTH SUITE L1
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-2525
Mailing Address - Country:US
Mailing Address - Phone:732-331-3400
Mailing Address - Fax:
Practice Address - Street 1:763 CONVERY BLVD
Practice Address - Street 2:ROUTE 35 SOUTH SUITE L1
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-2525
Practice Address - Country:US
Practice Address - Phone:732-331-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography