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General NPI Number Information
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NPI Number | 1316708092
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Entity Type | Individual
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Provider Name | RORY CARROLL AGPCNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 19 BRADHURST AVE STE 3060N
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City | HAWTHORNE
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State | NY
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Zip | 10532-2180
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Country | US
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Telephone | 914-372-7887
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Fax | 914-372-7884
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Provider Business Mailing Address
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Address Line | 250 S CENTRAL AVE APT 5H
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City | HARTSDALE
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State | NY
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Zip | 10530-3175
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Country | US
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Telephone | 518-605-0001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 311495
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License Number State | NY
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