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NPI Code Detail

MEDICARE: CARLOS REAL CASAC II

MEDICARE: CARLOS REAL CASAC II
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
1101YA0400XAddiction (Substance Use Disorder) Counselor12993NY

General Provider Information

NPI Number : 1730030735
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLOS REAL CASAC II
Provider Business Mailing Address
First Line : 311 E 175TH ST
Second Line :
City : BRONX
State : NY
Zip : 10457-5859
Country : US
Telephone Number : 718-960-7522
Fax Number : 718-583-6439
Provider Business Practice Location Address
First Line : 1776 CLAY AVE
Second Line :
City : BRONX
State : NY
Zip : 10457-7299
Country : US
Telephone Number : 718-960-7522
Fax Number : 718-583-6439
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2026
Last Update Date : 02/05/2026

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