Individual
CARL DESIDERIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
555 W 23RD ST, APT N 10 P, NEW YORK, NY 10011-1011
(212) 731-2187
Mailing address
555 W 23RD ST, APT N 10 P, NEW YORK, NY 10011-1011
(212) 731-2187
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MB03344700
NJ
207Q00000X
Family Medicine Physician
25MB03344700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1949306
—
NJ
Enumeration date
06/13/2006
Last updated
02/26/2018
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