Provider Demographics
NPI:1407068042
Name:MAGALHAES, CARLOS (DO)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:MAGALHAES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SPRINGVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2290
Mailing Address - Country:US
Mailing Address - Phone:631-283-1126
Mailing Address - Fax:631-283-7496
Practice Address - Street 1:3330 NOYAC RD BLDG A
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-1931
Practice Address - Country:US
Practice Address - Phone:631-725-2112
Practice Address - Fax:631-725-7180
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1407068042OtherNPI NUMBER
NYI01284Medicare UPIN
NYI01284Medicare UPIN
NY0279P05883Medicare PIN