Provider Demographics
NPI:1134383409
Name:KOENIGSMANN, CARL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOSEPH
Last Name:KOENIGSMANN
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 1:98 KIA ORA BLVD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541
Mailing Address - Country:US
Mailing Address - Phone:845-628-0273
Mailing Address - Fax:
Practice Address - Street 1:98 KIA ORA BLVD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4317
Practice Address - Country:US
Practice Address - Phone:845-628-0273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine