Mary Elaine Gines Carbonell, P.T.
Individual provider Active NPI Physical Therapist · Newark, NY
NPI 1104150341 · NPPES record last updated Jun 22, 2022
Key facts
- NPI
- 1104150341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 030046 (NY)
- Practice address
- 848 Peirson Ave
Newark, NY 14513-9762 - Phone
- (315) 879-2500
- NPI assigned
- Sep 21, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 030046 | NY | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 030046 | NY | Yes |
Addresses
Primary practice location
848 Peirson Ave
Newark, NY 14513-9762
Mailing address
848 Peirson Ave
Newark, NY 14513-9762
Phone (315) 331-2086
Other providers in Newark, NY
- Meggan Butler-O'Hara
- Peggy T Cain
- Molly J Campbell-Ellis
- Allison Lewis Campbell
- Grace S Candelario
- Jonathan S Carey
- Catholic Charities of the Diocese of Rochester
- Catholic Charities of the Diocese of Rochester
- John F Centonze
- Carrie Cerino
All providers in Newark, NY · Physical Therapist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.