=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124571807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CASEY L CARTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2016
-----------------------------------------------------
Last Update Date | 07/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 89 5TH AVE SUITE 307
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-3020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-546-7769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1675 GATES AVE #3L
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11385-2734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-546-7769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED ACUPUNCTURIST
-----------------------------------------------------
Name | CASEY LEIGH CARTY
-----------------------------------------------------
Credential | MS, L.AC.
-----------------------------------------------------
Telephone | 646-546-7769
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 005481-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------