Provider Demographics
NPI:1790188423
Name:CARAVELLO, JANIS
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:CARAVELLO
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 1:186 LOINES AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3214
Mailing Address - Country:US
Mailing Address - Phone:516-608-4193
Mailing Address - Fax:
Practice Address - Street 1:186 LOINES AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3214
Practice Address - Country:US
Practice Address - Phone:516-608-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY85949782174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist