Provider Demographics
NPI:1467962977
Name:SOUTH CARRIAGE
Entity Type:Organization
Organization Name:SOUTH CARRIAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:585-331-6752
Mailing Address - Street 1:PO BOX 70243
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-0243
Mailing Address - Country:US
Mailing Address - Phone:585-331-6752
Mailing Address - Fax:
Practice Address - Street 1:512 BEACH DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1004
Practice Address - Country:US
Practice Address - Phone:585-331-6752
Practice Address - Fax:585-331-6752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006888213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty