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1619779311 NPI number — SARINE CARROLL DO

NPI Number: 1619779311
Health Care Provider/Practitioner: SARINE CARROLL DO

Information about “1619779311” NPI (SARINE CARROLL DO) exists in 1619779311 in HTML format HTML  |  1619779311 in plain Text format TXT  |  1619779311 in PDF (Portable Document Format) PDF  |  1619779311 in an XML format XML  formats.

NPI Number : 1619779311 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619779311",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CARROLL",
    "FirstName": "SARINE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ARSLANIAN",
    "OtherFirstName": "SARINE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "DO",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "210 N WELLS ST APT 2107",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60606-1341",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-520-5286",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2160 S 1ST AVE STE 1940",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MAYWOOD",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60153-3328",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "708-216-6200",
    "PracticeLocationAddressFaxNumber": "708-216-6840",
    "EnumerationDate": "03/25/2025",
    "LastUpdateDate": "06/30/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "125.087034",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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