Provider Demographics
NPI:1750420899
Name:O'NEILL, CARRIE Z (DPM)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:Z
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1259
Mailing Address - Country:US
Mailing Address - Phone:315-331-5059
Mailing Address - Fax:315-331-5482
Practice Address - Street 1:165 W SHORE BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1259
Practice Address - Country:US
Practice Address - Phone:315-331-5059
Practice Address - Fax:315-331-5482
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO5548213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01955462Medicaid
NY106106EQOtherPREFERRED CARE
NYPO10005548OtherEXCELLUS BCBS
NY106106EQOtherPREFERRED CARE
NY01955462Medicaid