Provider Demographics
NPI:1033186291
Name:CARRASCO, MAIQUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MAIQUEL
Middle Name:
Last Name:CARRASCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 EAST 75TH STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3317
Mailing Address - Country:US
Mailing Address - Phone:212-772-3722
Mailing Address - Fax:212-794-3425
Practice Address - Street 1:328 E 75TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3317
Practice Address - Country:US
Practice Address - Phone:212-772-3722
Practice Address - Fax:212-794-3425
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206772-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01796730Medicaid
NYG610723Medicare UPIN
NY01796730Medicaid