Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 141330 | NY |
N | 111NI0900X | Internist | 141330 | NY |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 141330 | NY |
NPI | 1063487908 |
---|---|
Provider Name | Carlos Arevalo |
First Address | Elmhurst, NY 11373-1152 |
Second Address | Elmhurst, NY 11373-1152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 30/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00461367 | (05) | NY |
B88615 | (02) | NY |