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General NPI Number Information
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NPI Number | 1588982912
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Entity Type | Organization
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Legal Business Name | NORTHEAST NATURAL MEDICINE, LLC
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Dates
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Enumeration Date | 05/10/2010
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 33 MAIN ST SUITE 15
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City | NEWTOWN
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State | CT
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Zip | 06470-2129
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Country | US
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Telephone | 800-723-2962
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Fax | 800-957-5421
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Provider Business Mailing Address
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Address Line | 107 EDGELAKE DR
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City | SANDY HOOK
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State | CT
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Zip | 06482-1140
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Country | US
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Telephone | 203-947-2412
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Fax | 800-957-5421
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Authorized Official
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Title or Position | OWNER PRESIDENT MANAGER
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Name | DR. SHAWN MORGAN CARNEY
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Credential | N.D.
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Telephone | 800-723-2962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 004130
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 425
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License Number State | CT
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