Provider Demographics
NPI:1467789206
Name:SECOND OPINION MEDICINE, PLLC
Entity Type:Organization
Organization Name:SECOND OPINION MEDICINE, PLLC
Other - Org Name:COUNTRY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:P. CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GARELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-960-8055
Mailing Address - Street 1:670 STONELEIGH AVE
Mailing Address - Street 2:SUITE C-122
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3997
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:670 STONELEIGH AVE
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3997
Practice Address - Country:US
Practice Address - Phone:914-960-8055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No251F00000XAgenciesHome InfusionGroup - Multi-Specialty