1275680068 NPI number — DR. STEPHAN MICHAEL CARLSON MD

Table of content: DR. STEPHAN MICHAEL CARLSON MD (NPI 1275680068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275680068 NPI number — DR. STEPHAN MICHAEL CARLSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLSON
Provider First Name:
STEPHAN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1275680068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BROOKDALE PLZ STE 666
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11212-3198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-240-5811
Provider Business Mailing Address Fax Number:
718-240-5805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE BROOKDALE PLAZA
Provider Second Line Business Practice Location Address:
DEPT. OF PSYCHIATRY
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11212-3198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-240-6059
Provider Business Practice Location Address Fax Number:
718-240-5986
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084F0202X , with the licence number:  2436561 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 243656 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03013141 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com