Basic Information
| Provider Information | |||||||||
| NPI: | 1487247722 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARBON HEALTH MEDICAL GROUP OF FLORIDA PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 PACIFIC AVE | ||||||||
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| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941112009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152002133 | ||||||||
| FaxNumber: | 8889721912 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 HAVEMEYER ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112113340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152002099 | ||||||||
| FaxNumber: | 8889721912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2021 | ||||||||
| LastUpdateDate: | 02/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | PAPA | ||||||||
| AuthorizedOfficialFirstName: | GIANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6178941718 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.