Basic Information
Provider Information | |||||||||
NPI: | 1922043041 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ENG | ||||||||
FirstName: | CARLA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | YEE ENG | ||||||||
OtherFirstName: | CARLA | ||||||||
OtherMiddleName: | LAI | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 110 S BEDFORD RD | ||||||||
Address2: | CAREMOUNT MEDICAL PC | ||||||||
City: | MOUNT KISCO | ||||||||
State: | NY | ||||||||
PostalCode: | 105493446 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9142411050 | ||||||||
FaxNumber: | 9142421516 | ||||||||
Practice Location | |||||||||
Address1: | 2507 SOUTH RD | ||||||||
Address2: |   | ||||||||
City: | POUGHKEEPSIE | ||||||||
State: | NY | ||||||||
PostalCode: | 126015458 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8452315600 | ||||||||
FaxNumber: | 8454323932 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/20/2006 | ||||||||
LastUpdateDate: | 11/16/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 202289 | NY | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 02326814 | 05 | NY |   | MEDICAID |