MEDICARE: DR. GARY R CARPENTER JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	276449	NY

General Provider Information

NPI Number	:	1649533738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY R CARPENTER JR. M.D.

Provider Business Mailing Address
First Line	:	535 CLINTON AVE BSMT
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2201
Country	:	US
Telephone Number	:	718-789-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 GREENE AVE
Second Line	:	LLB
City	:	BROOKLYN
State	:	NY
Zip	:	11238-6406
Country	:	US
Telephone Number	:	718-789-5900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2012
Last Update Date	:	01/30/2019

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