1538623384 NPI number — CARLOS ANTONIO MIRANDA BELLO

Table of content: CARLOS ANTONIO MIRANDA BELLO (NPI 1538623384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538623384 NPI number — CARLOS ANTONIO MIRANDA BELLO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRANDA BELLO
Provider First Name:
CARLOS
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIRANDA
Provider Other First Name:
CARLOS
Provider Other Middle Name:
ANTONIO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1538623384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SUNY DOWNSTATE
Provider Second Line Business Mailing Address:
450 CLARKSON AVENUE, BOX 6
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11203-2012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-270-1000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUNY DOWNSTATE
Provider Second Line Business Practice Location Address:
450 CLARKSON AVENUE
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203-2012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-270-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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