1346261021 NPI number — CHRISTINE ELCIK CAROSELLA MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346261021 NPI number — CHRISTINE ELCIK CAROSELLA MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CAROSELLA

Provider First Name:

CHRISTINE

Provider Middle Name:

ELCIK

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1346261021

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/29/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

95 GRASSLANDS RD-NYMC

Provider Second Line Business Mailing Address:

DEPT OF MEDICINE-MUNGER PAVILION

Provider Business Mailing Address City Name:

VALHALLA

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

10595

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

914-493-8370

Provider Business Mailing Address Fax Number:

914-594-4434

Provider First Line Business Practice Location Address:

311 NORTH ST

Provider Second Line Business Practice Location Address:

SUITE 207

Provider Business Practice Location Address City Name:

WHITE PLAINS

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

10605

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

914-681-0926

Provider Business Practice Location Address Fax Number:

914-681-1354

Provider Enumeration Date:

07/21/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  196813 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0530846 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: WP787 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
• Identifier: 4C7239 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
• Identifier: 992203 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
• Identifier: CC6813 . This is a "ATLANTIS" identifier . This identifiers is of the category "OTHER".
• Identifier: 110108414 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 5957132 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2505721 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 746982 . This is a "BCBS OF NY WHITE PLAINS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 01619525 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 00000025694 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".