Provider Demographics
NPI:1730366295
Name:CAROLAN, EDWARD JAMES II
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JAMES
Last Name:CAROLAN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1811
Mailing Address - Country:US
Mailing Address - Phone:732-499-9464
Mailing Address - Fax:732-499-9464
Practice Address - Street 1:141 VALLEY RD
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1811
Practice Address - Country:US
Practice Address - Phone:732-499-9464
Practice Address - Fax:732-499-9464
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01666700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist