Provider Demographics
NPI:1083929913
Name:NEVILLE W, CARMICAL MD PC
Entity Type:Organization
Organization Name:NEVILLE W, CARMICAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CARMICAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-755-2575
Mailing Address - Street 1:305 E 55TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4148
Mailing Address - Country:US
Mailing Address - Phone:212-755-2575
Mailing Address - Fax:212-752-2865
Practice Address - Street 1:305 E 55TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4148
Practice Address - Country:US
Practice Address - Phone:212-755-2575
Practice Address - Fax:212-752-2865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100639207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty