Provider Demographics
NPI:1326814344
Name:FELICIANO, CARMELO JR (CPRS)
Entity Type:Individual
Prefix:
First Name:CARMELO
Middle Name:
Last Name:FELICIANO
Suffix:JR
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 JOHN F KENNEDY BLVD APT 407
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1670
Mailing Address - Country:US
Mailing Address - Phone:201-912-9640
Mailing Address - Fax:
Practice Address - Street 1:595 COUNTY AVE BLDG 6
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2605
Practice Address - Country:US
Practice Address - Phone:201-583-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJCPRS-50362175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist