Healthcare Provider Details

I. General information

NPI: 1649229055
Provider Name (Legal Business Name): KYM M. CARPENTIERI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 STATION RD SUITE 5-6
BELLPORT NY
11713-2449
US

IV. Provider business mailing address

16 STATION RD SUITE 5-6
BELLPORT NY
11713-2449
US

V. Phone/Fax

Practice location:
  • Phone: 631-286-3995
  • Fax: 631-286-4573
Mailing address:
  • Phone: 631-286-3995
  • Fax: 631-286-4573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number223141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: