1861540346 NPI number — DR. DOREEN LEIGH CARTER O.D.

Table of content: DR. DOREEN LEIGH CARTER O.D. (NPI 1861540346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861540346 NPI number — DR. DOREEN LEIGH CARTER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTER
Provider First Name:
DOREEN
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1861540346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61 VAN SCOY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHQUAG
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12570-5234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-227-2394
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 WEST 42ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-938-5888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  VUT 005794-1 , 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)

  • Identifier: U67544 . This is a "MEDICARE UPIN" identifier . This identifiers is of the category "OTHER".