Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | X2650 | NY |
NPI | 1720186901 |
---|---|
Provider Name | Dr. Carl B Hardy |
First Address | Syosset, NY 11791-4532 |
Second Address | Syosset, NY 11791-4532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T52670 | (02) | NY |