Provider Demographics
NPI:1952392623
Name:CAROTENUTO, DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:CAROTENUTO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 ROUTE 34
Mailing Address - Street 2:STE. 515
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2520
Mailing Address - Country:US
Mailing Address - Phone:732-409-0100
Mailing Address - Fax:732-409-1024
Practice Address - Street 1:411 ROUTE 34
Practice Address - Street 2:STE. 515
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2520
Practice Address - Country:US
Practice Address - Phone:732-409-0100
Practice Address - Fax:732-409-1024
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00485900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8562202Medicaid
P2521883OtherPXFORD
2588237OtherAETNA
1K8448OtherHEALTH NET- GUARDIAN
2117729OtherUNITED HEALTHCARE
5305010OtherCIGNA
P2521883OtherPXFORD
2588237OtherAETNA