Provider Demographics
NPI:1336127182
Name:ANNESE, CARLO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLO
Middle Name:
Last Name:ANNESE
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 1:35 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1730
Mailing Address - Country:US
Mailing Address - Phone:516-671-5474
Mailing Address - Fax:516-671-5454
Practice Address - Street 1:35 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-1730
Practice Address - Country:US
Practice Address - Phone:516-671-5474
Practice Address - Fax:516-671-5454
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70A201Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NYB18755Medicare UPIN