Provider Demographics
NPI:1003825274
Name:CARDONA, CARMEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:G
Last Name:CARDONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 COBBLERS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4474
Mailing Address - Country:US
Mailing Address - Phone:718-492-6952
Mailing Address - Fax:718-492-6972
Practice Address - Street 1:413 50TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-1912
Practice Address - Country:US
Practice Address - Phone:718-492-6952
Practice Address - Fax:718-492-6972
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196385207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01682948Medicaid
NY771261Medicare PIN