Provider Demographics
NPI:1578931929
Name:DICARRE NEW JERSEY LLC
Entity Type:Organization
Organization Name:DICARRE NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-337-6492
Mailing Address - Street 1:125 HALF MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6749
Mailing Address - Country:US
Mailing Address - Phone:732-337-6492
Mailing Address - Fax:
Practice Address - Street 1:125 HALF MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-6749
Practice Address - Country:US
Practice Address - Phone:732-337-6492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DICARRE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1959684332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies