Provider Demographics
NPI:1417678798
Name:GARMENDIA, CARMEN M
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:GARMENDIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4989
Mailing Address - Country:US
Mailing Address - Phone:973-777-3006
Mailing Address - Fax:973-777-5587
Practice Address - Street 1:121 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4989
Practice Address - Country:US
Practice Address - Phone:973-777-3006
Practice Address - Fax:973-777-5587
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01334300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty