Individual provider Active NPI

Edward Carbonell, MD

  • Internal Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1164416780
Registry record updated Nov 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
225949-1 Issued in NY
Practice address
445 Lenox Rd
Brooklyn, NY 11203-2017
Phone
(718) 270-7302
NPI assigned
Sep 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 225949-1 NY Primary

Addresses

Primary practice location

445 Lenox Rd
Brooklyn, NY 11203-2017

Mailing address

445 Lenox Rd
Box 1262
Brooklyn, NY 11203-2017
Phone (718) 270-7302

Other identifiers 1

IdentifierTypeStateIssuer
02353831MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120309000046 CA Practitioner - Internal MedicinePractitioner - Hospice/Palliative Care 1254323942 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
53719CAMDMarriage & Family Therapist
225949-1NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthcare Partners Affiliates Medical Group CurrentSince Nov 1, 2011 Accepting new patients
Healthcare Partners Affiliates Medical Group Internal Medicine Current Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Nov 1, 2011 Accepting new patients
Memorial Medical Group Inc Past Accepting new patients

Locations

450 E Huntington Dr
Arcadia, CA 91006
Phone (626) 254-2100

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

1025 W Olympic Blvd
Los Angeles, CA 90015
Phone (213) 623-2225

988 S Fair Oaks Ave
Pasadena, CA 91105
Phone (626) 582-7980

601 Torrance Blvd
#1182
Redondo Beach, CA 90277

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352160000000",
    "number": "1164416780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 LENOX RD",
            "address_2": "BOX 1262",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032017",
            "telephone_number": "718-270-7302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 LENOX RD",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032017",
            "telephone_number": "718-270-7302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARBONELL",
        "first_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2012-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "225949-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02353831",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.