Healthcare Provider Details

I. General information

NPI: 1811064082
Provider Name (Legal Business Name): CARLOS MONTEAGUDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TPKE NASSAU UNIVERSITY MEDICAL CENTER
EAST MEADOW NY
11554-1859
US

IV. Provider business mailing address

11226 71ST RD
FOREST HILLS NY
11375-4643
US

V. Phone/Fax

Practice location:
  • Phone: 516-572-5419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number220524
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number220524
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number220524
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: