Provider Demographics
NPI:1437401577
Name:CORKIN, CARLA DEBORAH (DIP AC MSAOM, MSA)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:DEBORAH
Last Name:CORKIN
Suffix:
Gender:F
Credentials:DIP AC MSAOM, MSA
Other - Prefix:MRS
Other - First Name:CARLA
Other - Middle Name:DEBORAH
Other - Last Name:NEWMAN-CORKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29 BRADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-8137
Mailing Address - Country:US
Mailing Address - Phone:732-303-4172
Mailing Address - Fax:
Practice Address - Street 1:2517 RT 35 VALLEY PARK
Practice Address - Street 2:BUILDING B SUITE 101
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-0872
Practice Address - Country:US
Practice Address - Phone:732-303-4172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-14
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00094700171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
139486OtherNATIONAL CERTIFICATION COMMISSION FOR ACUPUNCTURE AND ORIENTAL MEDICINE -NCCAOM
NJ25MZ00094700OtherNEW JERSEY STATE LICENSE