Basic Information
| Provider Information | |||||||||
| NPI: | 1316087190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARSTENS | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 E STATE ST | ||||||||
| Address2: | PO BOX 1250 | ||||||||
| City: | GLOVERSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120781203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188838620 | ||||||||
| FaxNumber: | 5188835653 | ||||||||
| Practice Location | |||||||||
| Address1: | 4104 STATE HIGHWAY 30 | ||||||||
| Address2: | |||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120106202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188838620 | ||||||||
| FaxNumber: | 5188835653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 01/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 151815 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 151815 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00381420 | 05 | NY | MEDICAID | 10066330 | 01 | NY | CDPHP PROVIDER NUMBER | OTHER | 000402960003 | 01 | NY | BS PROVIDER NUMBER | OTHER | 6334B1 | 01 | NY | EMPIRE BC | OTHER |