Provider Demographics
NPI:1679896542
Name:EUGENE C. CARROCCIA, M.D.,P.A.
Entity Type:Organization
Organization Name:EUGENE C. CARROCCIA, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARROCCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-822-8200
Mailing Address - Street 1:8512 VENTNOR AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-2500
Mailing Address - Country:US
Mailing Address - Phone:609-822-8200
Mailing Address - Fax:609-822-8287
Practice Address - Street 1:8512 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:MARGATE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08402-2500
Practice Address - Country:US
Practice Address - Phone:609-822-8200
Practice Address - Fax:609-822-8287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2894700Medicaid
NJ2894700Medicaid