Provider Demographics
NPI:1063708568
Name:MARRERO PRATS, CARLOS C (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:C
Last Name:MARRERO PRATS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994 W JERICHO TPKE STE 104
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3211
Mailing Address - Country:US
Mailing Address - Phone:631-543-1440
Mailing Address - Fax:866-229-5063
Practice Address - Street 1:994 W JERICHO TPKE STE 104
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3211
Practice Address - Country:US
Practice Address - Phone:631-543-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325866208100000X, 208VP0014X, 207LP2900X
MDD0092257208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104595200Medicaid