Provider Demographics
NPI:1417604448
Name:EMILCAR, CARLO (STUDENT)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:EMILCAR
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 RUSTIC DR APT 6
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7466
Mailing Address - Country:US
Mailing Address - Phone:516-450-6523
Mailing Address - Fax:
Practice Address - Street 1:1415 RUSTIC DR APT 6
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7466
Practice Address - Country:US
Practice Address - Phone:516-450-6523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program