Provider Demographics
NPI:1336213693
Name:SILVA, CARLOS FREDY (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:FREDY
Last Name:SILVA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83-75 WOODHAVEN BLVD
Mailing Address - Street 2:# LB4
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1535
Mailing Address - Country:US
Mailing Address - Phone:718-805-3338
Mailing Address - Fax:718-441-4872
Practice Address - Street 1:83-75 WOODHAVEN BLVD
Practice Address - Street 2:# LB4
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1535
Practice Address - Country:US
Practice Address - Phone:718-805-3338
Practice Address - Fax:718-441-4872
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004464213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01094664Medicaid
NY164299OtherELDERPLAN
NY36909POtherHIP
NYP1884071OtherOXFORD MEDICARE ID
NYP1884071OtherOXFORD MEDICARE ID
NY36909POtherHIP