Basic Information
| Provider Information | |||||||||
| NPI: | 1790167799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARBUCCIA | ||||||||
| FirstName: | CRISTIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4422 THIRD AVE MILLS BLDG 3RD, | ||||||||
| Address2: | DEPT OF INTERNAL MEDICINE | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104572545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189609000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33 UPPER RIVERDALE RD SW STE 10 | ||||||||
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| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708977043 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2015 | ||||||||
| LastUpdateDate: | 08/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 80551 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.