Basic Information
| Provider Information | |||||||||
| NPI: | 1386170314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARUSO | ||||||||
| FirstName: | ERIC | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1138 PINE ST | ||||||||
| Address2: | APT 303 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191076051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405228358 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 W TABOR RD | ||||||||
| Address2: | MOSS BUILDING, 3RD FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191413019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154563930 | ||||||||
| FaxNumber: | 2154561432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 05/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA058952 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.