Healthcare Provider Details

I. General information

NPI: 1255256970
Provider Name (Legal Business Name): BRANDON ROBERT CARBONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E PARK AVE
LONG BEACH NY
11561-2505
US

IV. Provider business mailing address

604 E PARK AVE
LONG BEACH NY
11561-2505
US

V. Phone/Fax

Practice location:
  • Phone: 516-432-0011
  • Fax:
Mailing address:
  • Phone: 516-432-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: