Provider Demographics
NPI:1023351079
Name:BLACK, CAROLINE O (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:O
Last Name:BLACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROLINE
Other - Middle Name:O
Other - Last Name:ADEGITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1149 ONE GUSTATVE PLACE
Mailing Address - Street 2:MT SINAI MEDICAL CENTER DEPT OF EMERGENCY MEDICINE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-0311
Mailing Address - Country:US
Mailing Address - Phone:212-824-8069
Mailing Address - Fax:212-241-1279
Practice Address - Street 1:EMERGENCY DEPARTMENT
Practice Address - Street 2:5 PERRYRIDGE ROAD
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830
Practice Address - Country:US
Practice Address - Phone:032-863-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10612900207PP0204X
CT79850207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine