Provider Demographics
NPI:1821560848
Name:CARFORA MEDICAL HEALTH WELLNESS PLLC
Entity Type:Organization
Organization Name:CARFORA MEDICAL HEALTH WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARFORA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-250-9582
Mailing Address - Street 1:412 N COUNTRY RD STE 10
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1761
Mailing Address - Country:US
Mailing Address - Phone:631-250-9582
Mailing Address - Fax:631-250-9615
Practice Address - Street 1:412 N COUNTRY RD STE 10
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1761
Practice Address - Country:US
Practice Address - Phone:631-250-9582
Practice Address - Fax:631-250-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service