Provider Demographics
NPI:1093838336
Name:CARPENTIERI, MARY M (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:CARPENTIERI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:MORAN
Other - Last Name:CARPENTIERI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1010 MCKINLEY ST
Mailing Address - Street 2:APT E20
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-5664
Mailing Address - Country:US
Mailing Address - Phone:914-739-1858
Mailing Address - Fax:
Practice Address - Street 1:1010 MCKINLEY ST
Practice Address - Street 2:APT E20
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-5664
Practice Address - Country:US
Practice Address - Phone:914-739-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320720-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01431149Medicaid