Provider Demographics
NPI:1366009227
Name:ANTON, CARRIE V (LAC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:V
Last Name:ANTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:5-19 BORDEN AVENUE
Mailing Address - Street 2:10K
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5899
Mailing Address - Country:US
Mailing Address - Phone:917-501-2199
Mailing Address - Fax:
Practice Address - Street 1:141 W 28TH ST RM 301
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6115
Practice Address - Country:US
Practice Address - Phone:646-926-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005065171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist