Provider Demographics
NPI:1467513119
Name:DICARLO, JILMA PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JILMA
Middle Name:PATRICIA
Last Name:DICARLO
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 1:2110 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-4744
Mailing Address - Country:US
Mailing Address - Phone:908-756-7500
Mailing Address - Fax:
Practice Address - Street 1:2110 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-4744
Practice Address - Country:US
Practice Address - Phone:908-756-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05552000261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty