Provider Demographics
NPI:1386645901
Name:BONTEMPO, CARL P (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:P
Last Name:BONTEMPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C. PETER
Other - Middle Name:
Other - Last Name:BONTEMPO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:279 3RD AVE
Mailing Address - Street 2:STE. 204
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6211
Mailing Address - Country:US
Mailing Address - Phone:732-291-8362
Mailing Address - Fax:732-571-9212
Practice Address - Street 1:279 3RD AVE
Practice Address - Street 2:STE. 204
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6211
Practice Address - Country:US
Practice Address - Phone:732-291-8362
Practice Address - Fax:732-571-9212
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04615600207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC60568Medicare UPIN
NJ539168Medicare ID - Type Unspecified