Provider Demographics
NPI:1588068910
Name:HAMILTON, CARROL
Entity type:Individual
Prefix:
First Name:CARROL
Middle Name:
Last Name:HAMILTON
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 1:130 GLENWOOD AVE
Mailing Address - Street 2:#33
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2649
Mailing Address - Country:US
Mailing Address - Phone:718-791-3780
Mailing Address - Fax:
Practice Address - Street 1:130 GLENWOOD AVE
Practice Address - Street 2:#33
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2649
Practice Address - Country:US
Practice Address - Phone:718-791-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269289372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion