Provider Demographics
NPI:1679824122
Name:CARMODY, JOSEPHINE MARIE
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:MARIE
Last Name:CARMODY
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 1:252 SHEAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-3630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:953 ROUTE 6
Practice Address - Street 2:SUITE 202
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1717
Practice Address - Country:US
Practice Address - Phone:845-208-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008922-1225100000X
CT004893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
QP1801Medicare PIN