Provider Demographics
NPI:1184794208
Name:HNETILA, CAROL A (DO)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:HNETILA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E 76TH ST
Mailing Address - Street 2:17J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3138
Mailing Address - Country:US
Mailing Address - Phone:718-920-7255
Mailing Address - Fax:718-405-5953
Practice Address - Street 1:MMC - CHILD ANNEX
Practice Address - Street 2:3300 KOSSUTH AVENUE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-7255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1356252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry