Provider Demographics
NPI:1124571807
Name:CASEY L CARTY
Entity Type:Organization
Organization Name:CASEY L CARTY
Other - Org Name:CASEY LEIGH CARTY MS, L.AC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAC
Authorized Official - Phone:646-546-7769
Mailing Address - Street 1:1675 GATES AVE
Mailing Address - Street 2:#3L
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2734
Mailing Address - Country:US
Mailing Address - Phone:646-546-7769
Mailing Address - Fax:
Practice Address - Street 1:89 5TH AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3020
Practice Address - Country:US
Practice Address - Phone:646-546-7769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005481-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty