Provider Demographics
NPI:1457643553
Name:CARUNCHIO, MICHELE JILLIAN (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:JILLIAN
Last Name:CARUNCHIO
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 AIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1225
Mailing Address - Country:US
Mailing Address - Phone:201-988-9629
Mailing Address - Fax:
Practice Address - Street 1:70 HUDSON ST STE 7
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5618
Practice Address - Country:US
Practice Address - Phone:201-659-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0591871223S0112X
NY2904291223S0112X
NJ22DI024913071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery