Provider Demographics
NPI:1275617193
Name:CARPENTIERI, ADAM M (DO)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:M
Last Name:CARPENTIERI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 NEW YORK AVENUE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4601
Mailing Address - Country:US
Mailing Address - Phone:516-799-2555
Mailing Address - Fax:516-799-2595
Practice Address - Street 1:119 NEW YORK AVENUE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4601
Practice Address - Country:US
Practice Address - Phone:516-799-2555
Practice Address - Fax:516-799-2595
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219334207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02460204Medicaid
H54624Medicare UPIN
NY5D9581Medicare PIN