Provider Demographics
NPI:1477971950
Name:CARTER, GARY G JR (LPN)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:G
Last Name:CARTER
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:G
Other - Last Name:CARTER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:227 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-480-8819
Mailing Address - Fax:
Practice Address - Street 1:227 ALLEN ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-480-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318161164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse