Provider Demographics
NPI:1295921443
Name:ULEP, CARMENCITA RAZO (MD)
Entity type:Individual
Prefix:DR
First Name:CARMENCITA
Middle Name:RAZO
Last Name:ULEP
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 1:9245 WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1871
Mailing Address - Country:US
Mailing Address - Phone:917-597-3418
Mailing Address - Fax:718-479-4567
Practice Address - Street 1:9245 WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1871
Practice Address - Country:US
Practice Address - Phone:917-597-3418
Practice Address - Fax:718-479-4567
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166052208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02816122Medicaid