Healthcare Provider Details

I. General information

NPI: 1578257341
Provider Name (Legal Business Name): DANA CARASIG MD-MRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 FRANKLIN AVE
MASSAPEQUA NY
11758-4925
US

IV. Provider business mailing address

11 UPPER POND CT
CENTERPORT NY
11721-1556
US

V. Phone/Fax

Practice location:
  • Phone: 800-526-9341
  • Fax:
Mailing address:
  • Phone: 631-816-7995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License NumberSAT-229
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberCN-0010018
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: