Basic Information
| Provider Information | |||||||||
| NPI: | 1205879814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYTLE | ||||||||
| FirstName: | CAROLE | ||||||||
| MiddleName: | FILOWITZ | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085618600 | ||||||||
| FaxNumber: | 9085617265 | ||||||||
| Practice Location | |||||||||
| Address1: | 34 MOUNTAIN BLVD | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070592640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087690100 | ||||||||
| FaxNumber: | 9087692512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA06663300 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7149131 | 01 | NJ | AETNA PROVIDER # | OTHER | 2355288 | 01 | NJ | AETNA US HEALTHCARE | OTHER | 1K6522 | 01 | NJ | HEALTHNET PROVIDER # | OTHER |