Provider Demographics
NPI:1356362180
Name:GERMINARIO, CARLA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:ANN
Last Name:GERMINARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:41 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2502
Mailing Address - Country:US
Mailing Address - Phone:201-819-4029
Mailing Address - Fax:201-934-5198
Practice Address - Street 1:15 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4508
Practice Address - Country:US
Practice Address - Phone:201-487-3355
Practice Address - Fax:201-487-0960
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07800600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI23911Medicare UPIN
NJ087322Medicare ID - Type Unspecified