Healthcare Provider Details

I. General information

NPI: 1962694521
Provider Name (Legal Business Name): MR. DAVID CARR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 E MAIN ST
RIVERHEAD NY
11901
US

IV. Provider business mailing address

20 MEDFORD AVE
PATCHOGUE NY
11772
US

V. Phone/Fax

Practice location:
  • Phone: 631-369-2808
  • Fax: 631-369-6900
Mailing address:
  • Phone: 631-447-7938
  • Fax: 631-447-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number14000007960
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: