Healthcare Provider Details

I. General information

NPI: 1912134404
Provider Name (Legal Business Name): CAROLYNE JEAN-PHILIPPE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SUNRISE HWY
ROCKVILLE CENTRE NY
11570-4908
US

IV. Provider business mailing address

192 FRANKLIN AVE
MALVERNE NY
11565-1934
US

V. Phone/Fax

Practice location:
  • Phone: 516-763-4764
  • Fax:
Mailing address:
  • Phone: 973-687-5113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number275171
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08595500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: