Healthcare Provider Details

I. General information

NPI: 1558309112
Provider Name (Legal Business Name): GRAZIANO CARLO CARLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E 58TH ST APT. 39A
NEW YORK NY
10022-2300
US

IV. Provider business mailing address

425 E 58TH ST APT. 39A
NEW YORK NY
10022-2300
US

V. Phone/Fax

Practice location:
  • Phone: 212-758-0134
  • Fax: 212-758-8315
Mailing address:
  • Phone: 212-758-0134
  • Fax: 212-758-8315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number128488
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number128488
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: