Individual
MS. CARLA MARIE WANUKOVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
29 PURITAN AVE, EAST PATCHOGUE, NY 11772-5516
(631) 626-0964
(631) 569-4761
Mailing address
29 PURITAN AVE, EAST PATCHOGUE, NY 11772-5516
(631) 626-0964
(631) 569-4761
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1552615
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
174400000X
SPECIALIST
NY
Enumeration date
06/19/2012
Last updated
06/19/2012
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