Provider Demographics
NPI:1972681377
Name:WILLIAM P CARNEY MD LLC
Entity Type:Organization
Organization Name:WILLIAM P CARNEY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RESTREPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-444-4447
Mailing Address - Street 1:127 UNION ST
Mailing Address - Street 2:STE 105
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-0000
Mailing Address - Country:US
Mailing Address - Phone:201-444-4447
Mailing Address - Fax:201-444-5155
Practice Address - Street 1:127 UNION STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:RIDGEWOOD,
Practice Address - State:NJ
Practice Address - Zip Code:07450-0000
Practice Address - Country:US
Practice Address - Phone:201-444-4447
Practice Address - Fax:201-444-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06275800207X00000X
NJ40QA00907400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099666OtherMEDICARE GROUP NUMBER