Healthcare Provider Details

I. General information

NPI: 1144100017
Provider Name (Legal Business Name): CARLEY M HIGGINS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BLUE SLIP APT 16G
BROOKLYN NY
11222-6753
US

IV. Provider business mailing address

1 BLUE SLIP APT 16G
BROOKLYN NY
11222-6753
US

V. Phone/Fax

Practice location:
  • Phone: 570-982-9775
  • Fax:
Mailing address:
  • Phone: 570-982-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: