Provider Demographics
NPI:1437150711
Name:CANLAS, CARMEN C (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:C
Last Name:CANLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 KENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1421
Mailing Address - Country:US
Mailing Address - Phone:973-927-0037
Mailing Address - Fax:
Practice Address - Street 1:5B DOCTORS PARK
Practice Address - Street 2:SEBER RD.
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1716
Practice Address - Country:US
Practice Address - Phone:908-852-8096
Practice Address - Fax:908-852-5012
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA028561002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6190006Medicaid
E54119Medicare UPIN