Provider Demographics
NPI:1902088982
Name:FIERRO, CAROLINE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:FIERRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 W MONTAUK HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2345
Mailing Address - Country:US
Mailing Address - Phone:631-723-2225
Mailing Address - Fax:631-723-2299
Practice Address - Street 1:182 W MONTAUK HWY
Practice Address - Street 2:SUITE B
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2345
Practice Address - Country:US
Practice Address - Phone:631-723-2227
Practice Address - Fax:631-723-2299
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212613174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H05457Medicare UPIN
NY9Y0653Medicare PIN