Provider Demographics
NPI:1144296187
Name:DESARNO, CARNEY THOMAS (MD)
Entity type:Individual
Prefix:
First Name:CARNEY
Middle Name:THOMAS
Last Name:DESARNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3460
Mailing Address - Country:US
Mailing Address - Phone:732-695-1617
Mailing Address - Fax:732-493-6319
Practice Address - Street 1:1820 CORLIES AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4860
Practice Address - Country:US
Practice Address - Phone:732-775-5005
Practice Address - Fax:732-775-0064
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA064976208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ012678Medicare ID - Type Unspecified
NJG76070Medicare UPIN