1336485200 NPI number — MR. REMIL ANTONIO CARABALLO CASAC-T

Table of content: MR. REMIL ANTONIO CARABALLO CASAC-T (NPI 1336485200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336485200 NPI number — MR. REMIL ANTONIO CARABALLO CASAC-T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARABALLO
Provider First Name:
REMIL
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CASAC-T
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:
1336485200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2640 8TH AVE APT 2C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10030-3426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-365-4569
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2090 7TH AVE
Provider Second Line Business Practice Location Address:
7TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10027-4990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-772-0201
Provider Business Practice Location Address Fax Number:
718-772-0260
Provider Enumeration Date:
12/21/2012

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: 101YA0400X , with the licence number:  27615 , 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)





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