Provider Demographics
NPI:1659428175
Name:CARPIN, MICHAEL JEFFREY (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JEFFREY
Last Name:CARPIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1157
Mailing Address - Country:US
Mailing Address - Phone:585-924-3250
Mailing Address - Fax:585-924-5127
Practice Address - Street 1:274 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1157
Practice Address - Country:US
Practice Address - Phone:585-924-3250
Practice Address - Fax:585-924-5127
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010019558OtherEXCELLUS 1
NY7574307OtherAETNA
NY107162FTOtherPREFERRED CARE
NY201606893OtherUNITED HEALTHCARE
NY107162FTOtherPREFERRED CARE