=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578257341
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA CARASIG MD-MRO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2023
-----------------------------------------------------
Last Update Date | 06/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 546 FRANKLIN AVE
-----------------------------------------------------
City | MASSAPEQUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11758-4925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-526-9341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 UPPER POND CT
-----------------------------------------------------
City | CENTERPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11721-1556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-816-7995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | CN-0010018
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2083T0002X
-----------------------------------------------------
Taxonomy Name | Medical Toxicology (Preventive Medicine) Physician
-----------------------------------------------------
License Number | SAT-229
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------