Provider Demographics
NPI:1922537844
Name:CLR CARTHAGE LLC
Entity Type:Organization
Organization Name:CLR CARTHAGE LLC
Other - Org Name:CARTHAGE PHYSICIAN GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-931-9700
Mailing Address - Street 1:4770 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1104
Mailing Address - Country:US
Mailing Address - Phone:718-931-9700
Mailing Address - Fax:
Practice Address - Street 1:1045 WEST ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-9762
Practice Address - Country:US
Practice Address - Phone:315-493-3221
Practice Address - Fax:315-493-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00774465Medicaid