Basic Information
| Provider Information | |||||||||
| NPI: | 1003136243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARRERA | ||||||||
| FirstName: | SANDRA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13705 249TH ST | ||||||||
| Address2: | |||||||||
| City: | ROSEDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114222241 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4224 GREENPOINT AVE | ||||||||
| Address2: | |||||||||
| City: | SUNNYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111043004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184826814 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2010 | ||||||||
| LastUpdateDate: | 09/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 258060 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.