Provider Demographics
NPI:1063490266
Name:CARLIN, MICHAEL LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:CARLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 N ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1608
Mailing Address - Country:US
Mailing Address - Phone:845-353-0400
Mailing Address - Fax:845-353-6858
Practice Address - Street 1:260 N ROUTE 303
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1608
Practice Address - Country:US
Practice Address - Phone:845-353-0400
Practice Address - Fax:845-353-6858
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1795072085N0700X, 2085R0202X
FLME946952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01554934Medicaid
NY02695HMedicare PIN
NYF70224Medicare UPIN
NY01554934Medicaid