Individual
CARLY GENNARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
1556 STRAIGHT PATH, WYANDANCH, NY 11798-3213
(516) 214-8020
(516) 214-8022
Mailing address
1000 MONTAUK HWY, WEST ISLIP, NY 11795-4927
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
414019797
NY
Other
Enumeration date
06/20/2016
Last updated
06/12/2019
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