Provider Demographics
NPI:1538978176
Name:MAMARADLO, CAREN BAUTISTA
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:BAUTISTA
Last Name:MAMARADLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08886-2649
Mailing Address - Country:US
Mailing Address - Phone:201-306-7333
Mailing Address - Fax:
Practice Address - Street 1:346 HAMILTON DR
Practice Address - Street 2:
Practice Address - City:STEWARTSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08886-2649
Practice Address - Country:US
Practice Address - Phone:201-306-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15234000363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology