Provider Demographics
NPI:1558458646
Name:HILTEBEITEL, CAROLYN B (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:B
Last Name:HILTEBEITEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4163
Mailing Address - Country:US
Mailing Address - Phone:212-746-0373
Mailing Address - Fax:212-746-7481
Practice Address - Street 1:12 W 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4163
Practice Address - Country:US
Practice Address - Phone:212-746-7800
Practice Address - Fax:212-746-7780
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201354208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6T8851Medicare ID - Type Unspecified
NYG86266Medicare UPIN