Healthcare Provider Details

I. General information

NPI: 1144687369
Provider Name (Legal Business Name): CARLOS ENRIQUE PADRON LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 DEBEVOISE ST STE 5
BROOKLYN NY
11206-4194
US

IV. Provider business mailing address

145 W 15TH ST FL 2
NEW YORK NY
10011-6701
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-4430
  • Fax:
Mailing address:
  • Phone: 212-924-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000936
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: