Provider Demographics
NPI:1457070120
Name:CARBONARA, ROBYN
Entity type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:
Last Name:CARBONARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 KINGDOM AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4403
Mailing Address - Country:US
Mailing Address - Phone:347-563-8999
Mailing Address - Fax:
Practice Address - Street 1:54 OSBORNE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5508
Practice Address - Country:US
Practice Address - Phone:718-697-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY475819174400000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist