Provider Demographics
NPI:1235275835
Name:ECHEVARRIA, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:ECHEVARRIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 E 68TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5844
Mailing Address - Country:US
Mailing Address - Phone:212-535-8990
Mailing Address - Fax:212-535-8990
Practice Address - Street 1:20 EAST 68 ST
Practice Address - Street 2:SUITE 206
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-535-8990
Practice Address - Fax:212-535-8990
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1438862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00554898Medicaid
NY89A381Medicare ID - Type Unspecified