Provider Demographics
NPI:1972717122
Name:OCASIO, CARLOS J (DDS)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:J
Last Name:OCASIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PARCOT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-1211
Mailing Address - Country:US
Mailing Address - Phone:914-633-9340
Mailing Address - Fax:718-584-0276
Practice Address - Street 1:2278 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-1039
Practice Address - Country:US
Practice Address - Phone:718-584-2274
Practice Address - Fax:718-584-0276
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01171397Medicaid