Provider Demographics
NPI:1568553170
Name:VINAS, CARLOS ALFONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALFONSO
Last Name:VINAS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14205 ROOSEVELT AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6045
Mailing Address - Country:US
Mailing Address - Phone:718-539-1033
Mailing Address - Fax:718-358-4144
Practice Address - Street 1:14205 ROOSEVELT AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6045
Practice Address - Country:US
Practice Address - Phone:718-539-1033
Practice Address - Fax:718-358-4144
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY116041208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00334670Medicaid
NY00334670Medicaid