Healthcare Provider Details

I. General information

NPI: 1720066467
Provider Name (Legal Business Name): STEPHEN F CAROLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 THEALL RD
RYE NY
10580-1404
US

IV. Provider business mailing address

1 THEALL RD
RYE NY
10580-1404
US

V. Phone/Fax

Practice location:
  • Phone: 914-848-8800
  • Fax: 914-848-8801
Mailing address:
  • Phone: 914-848-8800
  • Fax: 914-848-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number028686
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number174162-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number174162
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number028686
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: