Individual provider Active NPI

Carlos Augusto Montenegro

  • Ph.D. Medical Genetics
  • Brooklyn, NY
National Provider Identifier
1649284431
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ph.D. Medical GeneticsTaxonomy code 170100000X
License
227588 Issued in NY
Practice address
321 Pennsylvania Ave
Brooklyn, NY 11207-4101
Phone
(718) 395-9180
Fax
(718) 385-9477
NPI assigned
Jul 28, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ph.D. Medical Genetics 170100000X 227588 NY Primary

Addresses

Primary practice location

321 Pennsylvania Ave
Brooklyn, NY 11207-4101

Mailing address

9511 99TH Ave
Ozone Park, NY 11416-2515
Phone (718) 322-2688

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20040401000417 NY Practitioner - Internal MedicinePractitioner - General PracticePractitioner - Pain Management 5799777595 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
227588NYMDPh.D. Medical Genetics

Practice roles

OrganizationSpecialtyStatusNew patients
International Medical Services Current Accepting new patients

Locations

8915 175th St
Jamaica, NY 11432
Phone (718) 385-9180

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649284431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9511 99TH AVE",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "114162515",
            "telephone_number": "718-322-2688",
            "fax_number": "718-385-9180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 PENNSYLVANIA AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112074101",
            "telephone_number": "718-395-9180",
            "fax_number": "718-385-9477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTENEGRO",
        "first_name": "CARLOS",
        "middle_name": "AUGUSTO",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170100000X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Ph.D. Medical Genetics",
            "state": "NY",
            "license": "227588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.