Provider Demographics
NPI:1295839561
Name:INGRASSIA, CARL M (DPM)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:M
Last Name:INGRASSIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00215200213E00000X
NYN0049741213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6192505Medicaid
0000172893Medicare ID - Type Unspecified
NJ6192505Medicaid