Basic Information
Provider Information
NPI: 1386817948
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARR
FirstName: HEMLATA
MiddleName: JANELLE
NamePrefix:  
NameSuffix:  
Credential: N.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2570 ROUTE 9W
Address2: SUITE 10
City: CORNWALL
State: NY
PostalCode: 125181323
CountryCode: US
TelephoneNumber: 8452203100
FaxNumber: 8455342940
Practice Location
Address1: 147 LAKE STREET
Address2:  
City: NEWBURGH
State: NY
PostalCode: 125505242
CountryCode: US
TelephoneNumber: 8455638000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/03/2008
LastUpdateDate: 03/14/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X335434NYY Other Service ProvidersSpecialist 

No ID Information.


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