Healthcare Provider Details

I. General information

NPI: 1407126295
Provider Name (Legal Business Name): LYNETTE J CAROLI R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 STATE ROUTE 17K
MONTGOMERY NY
12549-2245
US

IV. Provider business mailing address

1175 STATE ROUTE 17K
MONTGOMERY NY
12549-2245
US

V. Phone/Fax

Practice location:
  • Phone: 845-457-2400
  • Fax: 845-457-4056
Mailing address:
  • Phone: 845-457-2400
  • Fax: 845-457-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number287150-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: