Provider Demographics
NPI:1821167040
Name:GANGEMI, CARMINE JOSEPH III (DC)
Entity Type:Individual
Prefix:DR
First Name:CARMINE
Middle Name:JOSEPH
Last Name:GANGEMI
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 W BLACKWELL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-2560
Mailing Address - Country:US
Mailing Address - Phone:973-343-6633
Mailing Address - Fax:973-343-6633
Practice Address - Street 1:369 W BLACKWELL ST STE 2
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2560
Practice Address - Country:US
Practice Address - Phone:973-343-6633
Practice Address - Fax:973-343-6633
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00776900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU85340Medicare UPIN