Healthcare Provider Details

I. General information

NPI: 1417899352
Provider Name (Legal Business Name): CARELOGIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W 140TH ST
NEW YORK NY
10030-1807
US

IV. Provider business mailing address

30 N GOULD ST STE 57859
SHERIDAN WY
82801-6317
US

V. Phone/Fax

Practice location:
  • Phone: 646-980-5989
  • Fax:
Mailing address:
  • Phone: 646-980-5989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: WALTER KEENEY
Title or Position: SUPERVISOR
Credential:
Phone: 646-980-5989