Provider Demographics
NPI:1972685725
Name:ENGLEBARDT, CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:ENGLEBARDT
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 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-393-3663
Mailing Address - Fax:518-346-3541
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-393-3663
Practice Address - Fax:518-346-3541
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116555208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00705486Medicaid
NY1901OtherMVP PROVIDER NUMBER
NY38660BMedicare PIN
NY00705486Medicaid