Provider Demographics
NPI:1659824464
Name:CARTY, CASEY LEIGH (MS, LAC)
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:LEIGH
Last Name:CARTY
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 GATES AVE
Mailing Address - Street 2:3L
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2734
Mailing Address - Country:US
Mailing Address - Phone:646-546-7769
Mailing Address - Fax:
Practice Address - Street 1:89 5TH AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3020
Practice Address - Country:US
Practice Address - Phone:646-546-7769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005481-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist