Provider Demographics
NPI:1477159705
Name:MCGUIRK, CARRIE ANN ANN
Entity Type:Individual
Prefix:
First Name:CARRIE ANN
Middle Name:ANN
Last Name:MCGUIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1501
Mailing Address - Country:US
Mailing Address - Phone:631-512-8390
Mailing Address - Fax:
Practice Address - Street 1:111 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1501
Practice Address - Country:US
Practice Address - Phone:631-512-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist