Provider Demographics
NPI:1811993652
Name:MINNITI, CARL JOSEPH JR (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOSEPH
Last Name:MINNITI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:174 DEMOCRAT RD
Mailing Address - Street 2:
Mailing Address - City:MICKLETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08056-1236
Mailing Address - Country:US
Mailing Address - Phone:856-423-0754
Mailing Address - Fax:856-423-7508
Practice Address - Street 1:174 DEMOCRAT RD
Practice Address - Street 2:
Practice Address - City:MICKLETON
Practice Address - State:NJ
Practice Address - Zip Code:08056-1236
Practice Address - Country:US
Practice Address - Phone:856-423-0754
Practice Address - Fax:856-423-7508
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51205174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6707700Medicaid
NJ6707700Medicaid
NJF93754Medicare UPIN