Provider Demographics
NPI:1801039631
Name:CARNEY T. DESARNO, MD, LLC
Entity Type:Organization
Organization Name:CARNEY T. DESARNO, MD, LLC
Other - Org Name:JERSEY SHORE ADVANCED SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARNEY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DESARNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-775-5005
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07754-0848
Mailing Address - Country:US
Mailing Address - Phone:732-775-5005
Mailing Address - Fax:732-775-0064
Practice Address - Street 1:1706 CORLIES AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4910
Practice Address - Country:US
Practice Address - Phone:732-775-5005
Practice Address - Fax:732-775-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA064976208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG76070Medicare UPIN
NJ152641Medicare PIN