Provider Demographics
NPI:1104008291
Name:CARLYLE SERVICES, INC.
Entity type:Organization
Organization Name:CARLYLE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOROVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-879-6630
Mailing Address - Street 1:70 E 77TH ST
Mailing Address - Street 2:SUITE 1 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1811
Mailing Address - Country:US
Mailing Address - Phone:212-734-4281
Mailing Address - Fax:212-650-9736
Practice Address - Street 1:70 E 77TH ST
Practice Address - Street 2:SUITE 1 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1811
Practice Address - Country:US
Practice Address - Phone:212-734-4281
Practice Address - Fax:212-650-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15000003624261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech