Provider Demographics
NPI:1558749614
Name:GARDEN, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:GARDEN
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 1:52 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1030
Mailing Address - Country:US
Mailing Address - Phone:347-249-3927
Mailing Address - Fax:718-346-2141
Practice Address - Street 1:52 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1030
Practice Address - Country:US
Practice Address - Phone:347-249-3927
Practice Address - Fax:718-346-2141
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-09
Last Update Date:2015-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY645476951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist