Provider Demographics
NPI:1619360708
Name:FLAHERTY, CARLY LOEWENSTEIN
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:LOEWENSTEIN
Last Name:FLAHERTY
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 1:221 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2924
Mailing Address - Country:US
Mailing Address - Phone:631-533-2888
Mailing Address - Fax:
Practice Address - Street 1:221 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2924
Practice Address - Country:US
Practice Address - Phone:631-533-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12595225100000X
NY038643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist