Provider Demographics
NPI:1629062591
Name:NATALI-AGOSTINI, CARMEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:A
Last Name:NATALI-AGOSTINI
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 1:260 5TH AVE
Mailing Address - Street 2:SUITE 12N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6408
Mailing Address - Country:US
Mailing Address - Phone:917-776-3496
Mailing Address - Fax:212-685-5331
Practice Address - Street 1:900 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3425
Practice Address - Country:US
Practice Address - Phone:718-732-7334
Practice Address - Fax:212-685-5331
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA073096002084A0401X
NY1684142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY168414OtherHIP
NY25612866OtherUNITED
NYP-616-436OtherOXFORD
NY1172012OtherCIGNA
NY455303OtherVALUE OTIONS
NY255277OtherVALUE OPTIONS EMPIRE
NJ0060887Medicaid
NY7346352OtherGHI
NY01029363Medicaid
NJB80337Medicare UPIN
NY255277OtherVALUE OPTIONS EMPIRE
NJ089210Medicare ID - Type Unspecified
NY25612866OtherUNITED