Provider Demographics
NPI:1780919357
Name:IRWIN, CAROLE LORRAINE (PT)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:LORRAINE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:2087 SHORE ROAD
Practice Address - Street 2:SUITE 24
Practice Address - City:SEAVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08230
Practice Address - Country:US
Practice Address - Phone:609-536-4995
Practice Address - Fax:609-624-2032
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00709000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist