Provider Demographics
NPI:1700575552
Name:GARDNER, SEAN CARTER
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:CARTER
Last Name:GARDNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 TOC DR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1551
Mailing Address - Country:US
Mailing Address - Phone:631-452-2303
Mailing Address - Fax:
Practice Address - Street 1:42 TOC DR UNIT 103
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1551
Practice Address - Country:US
Practice Address - Phone:631-452-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle