Healthcare Provider Details

I. General information

NPI: 1932180528
Provider Name (Legal Business Name): LYDA E. ROJAS CARROLL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 STONELEIGH AVE
CARMEL NY
10512-3990
US

IV. Provider business mailing address

672 STONELEIGH AVE
CARMEL NY
10512-3990
US

V. Phone/Fax

Practice location:
  • Phone: 845-278-6777
  • Fax:
Mailing address:
  • Phone: 845-278-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number186973
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: