Provider Demographics
NPI:1932520129
Name:CARLA LYNN SANGIORGIO
Entity Type:Organization
Organization Name:CARLA LYNN SANGIORGIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SANGIORGIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-227-2466
Mailing Address - Street 1:1080 RENSSELAER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2114
Mailing Address - Country:US
Mailing Address - Phone:718-227-2466
Mailing Address - Fax:
Practice Address - Street 1:1080 RENSSELAER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2114
Practice Address - Country:US
Practice Address - Phone:718-227-2466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-15
Last Update Date:2013-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY671937320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities