Healthcare Provider Details

I. General information

NPI: 1336981174
Provider Name (Legal Business Name): CARMEL GUSTAVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 E 89TH ST
BROOKLYN NY
11236-3245
US

IV. Provider business mailing address

584 E 89TH ST
BROOKLYN NY
11236-3245
US

V. Phone/Fax

Practice location:
  • Phone: 347-248-7780
  • Fax:
Mailing address:
  • Phone: 347-248-7780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number821915
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: