Provider Demographics
NPI:1831197334
Name:ADLER, CARL M (DO)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:M
Last Name:ADLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11006 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4900
Mailing Address - Country:US
Mailing Address - Phone:718-793-6779
Mailing Address - Fax:718-793-6950
Practice Address - Street 1:11006 72ND AVE
Practice Address - Street 2:SUITE MD1
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4900
Practice Address - Country:US
Practice Address - Phone:718-793-6779
Practice Address - Fax:718-793-6950
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02360Medicare ID - Type Unspecified
NYF66718Medicare UPIN