Organization
LADACIN NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICIA BLACK CARLESIMO (EXECUTIVE DIRECTOR)
(732) 493-5900
Entity
Organization
Contact information
Practice address
1701 KNEELEY BLVD, OCEAN, NJ 07712-7622
(732) 493-5900
(732) 493-5980
Mailing address
1701 KNEELEY BLVD, OCEAN, NJ 07712-7622
(732) 493-5900
(732) 493-5980
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012807
—
NJ
Enumeration date
03/06/2008
Last updated
03/06/2008
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