Healthcare Provider Details

I. General information

NPI: 1740413178
Provider Name (Legal Business Name): DR. LOUIS THOMAS CARDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 ERLAND RD
STONY BROOK NY
11790-1124
US

IV. Provider business mailing address

33 ERLAND RD
STONY BROOK NY
11790-1124
US

V. Phone/Fax

Practice location:
  • Phone: 631-689-8494
  • Fax: 631-689-8494
Mailing address:
  • Phone: 631-689-8494
  • Fax: 631-689-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number121378
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: