Provider Demographics
NPI:1497827091
Name:CARBONE, CAITLIN (DPT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:CARBONE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 ROCK RD
Mailing Address - Street 2:FL 2
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1745
Mailing Address - Country:US
Mailing Address - Phone:201-218-7533
Mailing Address - Fax:
Practice Address - Street 1:251 ROCK RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1745
Practice Address - Country:US
Practice Address - Phone:201-445-0900
Practice Address - Fax:201-445-0919
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01132200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ105789 M53Medicare PIN