Healthcare Provider Details

I. General information

NPI: 1548738172
Provider Name (Legal Business Name): CARL J JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 E MAIN ST STE 100
RIVERHEAD NY
11901-2521
US

IV. Provider business mailing address

16 ALAN ST
HOLBROOK NY
11741-1107
US

V. Phone/Fax

Practice location:
  • Phone: 631-803-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128629
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: