Provider Demographics
NPI:1295397222
Name:NEINAS, CARLEY BROOKE
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:BROOKE
Last Name:NEINAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLEY
Other - Middle Name:BROOKE
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:707 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2650
Mailing Address - Country:US
Mailing Address - Phone:845-333-7575
Mailing Address - Fax:845-333-7139
Practice Address - Street 1:273 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1163
Practice Address - Country:US
Practice Address - Phone:570-390-4545
Practice Address - Fax:570-390-4546
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023873363AM0700X
PAMA061098363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical