Basic Information
| Provider Information | |||||||||
| NPI: | 1972519478 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELYSE G CARTY ROBERT W CARTY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | BORDENTOWN FAMILY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 THIRD ST | ||||||||
| Address2: | |||||||||
| City: | BORDENTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085051321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092982005 | ||||||||
| FaxNumber: | 6093248267 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 THIRD STREET | ||||||||
| Address2: | |||||||||
| City: | BORDENTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085051321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092982005 | ||||||||
| FaxNumber: | 6093248267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | CARTY | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6092982005 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.