Healthcare Provider Details

I. General information

NPI: 1316987548
Provider Name (Legal Business Name): CARRIE BOWLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BROAD ST 45TH FLOOR
NEW YORK NY
10004-2304
US

IV. Provider business mailing address

30 BROAD ST 45TH FLOOR
NEW YORK NY
10004-2304
US

V. Phone/Fax

Practice location:
  • Phone: 212-530-0630
  • Fax: 212-867-4353
Mailing address:
  • Phone: 212-530-0630
  • Fax: 212-867-4353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A9581
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number261003
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: