| Carlson Medical Llc | |
|
385 S Maple Ave Ste 101 Glen Rock NJ 07452-1545 | |
| (201) 345-1855 | |
| Not Available |
| Full Name | Carlson Medical Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 385 S Maple Ave Ste 101, Glen Rock, New Jersey |
| Authorized Official Name and Position | Sandra Carlson (OWNER) |
| Authorized Official Contact | 2013451855 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carlson Medical Llc 385 S Maple Ave Ste 101 Glen Rock NJ 07452-1545 Ph: (201) 345-1855 | Carlson Medical Llc 385 S Maple Ave Ste 101 Glen Rock NJ 07452-1545 Ph: (201) 345-1855 |
| NPI Number | 1346787256 |
|---|---|
| Provider Enumeration Date | 01/30/2017 |
| Last Update Date | 02/27/2017 |
| Medicare PECOS PAC ID | 9739463977 |
|---|---|
| Medicare Enrollment ID | O20170307000596 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346787256 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Sandra Carlson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033321302 PECOS PAC ID: 3375696586 Enrollment ID: I20090806000095 |
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