1194802843 NPI number — STEPHEN S CARRYL, MD, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194802843 NPI number — STEPHEN S CARRYL, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN S CARRYL, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194802843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7247-7912
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19170-7912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-250-8944
Provider Business Mailing Address Fax Number:
718-250-8060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE HANSON PLACE
Provider Second Line Business Practice Location Address:
SUITE 710
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-783-0934
Provider Business Practice Location Address Fax Number:
718-857-0162
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARRYL
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-783-0934

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  191367 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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