Provider Demographics
NPI:1225380017
Name:NEGRON, CARLOS M (PT)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:M
Last Name:NEGRON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3146 29TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3302
Mailing Address - Country:US
Mailing Address - Phone:917-449-2517
Mailing Address - Fax:
Practice Address - Street 1:3146 29TH ST FL 1
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3302
Practice Address - Country:US
Practice Address - Phone:917-449-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010400-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist