Provider Demographics
NPI:1114472727
Name:CARMENLINO PAYUMO, MDPA
Entity Type:Organization
Organization Name:CARMENLINO PAYUMO, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARMENLINO
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAYUMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-826-4177
Mailing Address - Street 1:121 MEREDITH RD
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-3120
Mailing Address - Country:US
Mailing Address - Phone:732-826-4177
Mailing Address - Fax:732-607-1160
Practice Address - Street 1:205 MAY ST STE 103
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3267
Practice Address - Country:US
Practice Address - Phone:732-661-9075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02902600305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization