Provider Demographics
NPI:1649229055
Name:CARPENTIERI, KYM M (DO)
Entity Type:Individual
Prefix:DR
First Name:KYM
Middle Name:M
Last Name:CARPENTIERI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16 STATION RD
Mailing Address - Street 2:SUITE 5-6
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2449
Mailing Address - Country:US
Mailing Address - Phone:631-286-3995
Mailing Address - Fax:631-286-4573
Practice Address - Street 1:16 STATION RD
Practice Address - Street 2:SUITE 5-6
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2449
Practice Address - Country:US
Practice Address - Phone:631-286-3995
Practice Address - Fax:631-286-4573
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY223141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1992738538OtherNPI GROUP NUMBER
NY1649229055OtherNPI NUMBER
NYH92488Medicare UPIN
NY1649229055OtherNPI NUMBER