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NPI Code Detail

MEDICARE: CARLA G CARABALLO

MEDICARE: CARLA G CARABALLO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse267975-1NY

General Provider Information

NPI Number : 1356858823
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLA G CARABALLO
Provider Business Mailing Address
First Line : 2381 FREDERICK DOUGLASS BLVD
Second Line :
City : NEW YORK
State : NY
Zip : 10027-1822
Country : US
Telephone Number : 212-866-4400
Fax Number :
Provider Business Practice Location Address
First Line : 2381 FREDERICK DOUGLASS BLVD
Second Line :
City : NEW YORK
State : NY
Zip : 10027-1822
Country : US
Telephone Number : 212-866-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2018
Last Update Date : 01/05/2018

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