Provider Demographics
NPI:1558309369
Name:CARNEY, MICHELE EMILY (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:EMILY
Last Name:CARNEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-968-0508
Mailing Address - Fax:201-968-0509
Practice Address - Street 1:17 ELM AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4702
Practice Address - Country:US
Practice Address - Phone:201-968-0508
Practice Address - Fax:201-968-0509
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022150-1208100000X
NJ40QA01445600225100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist