MEDICARE: CARLEY BROOKE NEINAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	023873	NY
2	363A00000X	Physician Assistant	MA061098	PA

General Provider Information

NPI Number	:	1295397222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLEY BROOKE NEINAS

Provider Business Mailing Address
First Line	:	707 E MAIN ST
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-2650
Country	:	US
Telephone Number	:	845-333-7575
Fax Number	:	845-333-7139

Provider Business Practice Location Address
First Line	:	273 GRANDVIEW AVE
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-1163
Country	:	US
Telephone Number	:	570-390-4545
Fax Number	:	570-390-4546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2019
Last Update Date	:	08/16/2024

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Directions to “ CARLEY BROOKE NEINAS ” Practice Location

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