Healthcare Provider Details

I. General information

NPI: 1639941057
Provider Name (Legal Business Name): CARLEN PADMORE-GATEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLEN PADMORE-GATEAU

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11620 205TH ST
SAINT ALBANS NY
11412-2920
US

IV. Provider business mailing address

11620 205TH ST
SAINT ALBANS NY
11412-2920
US

V. Phone/Fax

Practice location:
  • Phone: 917-288-1774
  • Fax:
Mailing address:
  • Phone: 917-288-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number31321
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: