Provider Demographics
NPI:1801950480
Name:CARDULLO, ALICE C (MD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:C
Last Name:CARDULLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 RATZER RD
Mailing Address - Street 2:SUITE B9
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7702
Mailing Address - Country:US
Mailing Address - Phone:973-696-4806
Mailing Address - Fax:973-696-8980
Practice Address - Street 1:330 RATZER RD
Practice Address - Street 2:SUITE B9
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7702
Practice Address - Country:US
Practice Address - Phone:973-696-4806
Practice Address - Fax:973-696-8980
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ53127207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E53459Medicare UPIN
445767Medicare ID - Type Unspecified