Healthcare Provider Details

I. General information

NPI: 1477470813
Provider Name (Legal Business Name): LIZETTE CARRION
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E MAIN ST
SMITHTOWN NY
11787-2840
US

IV. Provider business mailing address

12 RIDGEWOOD AVE
BRENTWOOD NY
11717-2106
US

V. Phone/Fax

Practice location:
  • Phone: 631-880-7577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: