Provider Demographics
NPI:1023392354
Name:WESLEY V. CARRION, MD PC
Entity Type:Organization
Organization Name:WESLEY V. CARRION, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:VANWYE
Authorized Official - Last Name:CARRION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-751-3117
Mailing Address - Street 1:1 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1619
Mailing Address - Country:US
Mailing Address - Phone:631-751-3117
Mailing Address - Fax:631-751-8560
Practice Address - Street 1:1 SHORE DR
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1619
Practice Address - Country:US
Practice Address - Phone:631-751-3117
Practice Address - Fax:631-751-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1932276207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty