Healthcare Provider Details

I. General information

NPI: 1073528659
Provider Name (Legal Business Name): CARLOS F VIEJO M, D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 MALCOLM X BLVD W P 522
NEW YORK NY
10037-1802
US

IV. Provider business mailing address

506 MALCOLM X BLVD W P 522
NEW YORK NY
10037-1802
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-2740
  • Fax: 212-939-2759
Mailing address:
  • Phone: 212-939-2740
  • Fax: 212-939-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number191411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: