1639127830 NPI number — CAROLYN J AGRESTI M.D.

Table of content: CAROLYN J AGRESTI M.D. (NPI 1639127830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639127830 NPI number — CAROLYN J AGRESTI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGRESTI
Provider First Name:
CAROLYN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1639127830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1411 N FLAGLER DR STE 9700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33401-3422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-899-3822
Provider Business Mailing Address Fax Number:
561-899-3859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 N FLAGLER DR
Provider Second Line Business Practice Location Address:
STE 600
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33401-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-659-2266
Provider Business Practice Location Address Fax Number:
561-659-7846
Provider Enumeration Date:
05/04/2006

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: 207Y00000X , with the licence number:  ME69697 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 379496200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com