Provider Demographics
NPI:1154613321
Name:CANTAVE, INGRID CARMELLE (MD)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:CARMELLE
Last Name:CANTAVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:631-885-1201
Mailing Address - Fax:
Practice Address - Street 1:1345 MOTOR PKWY FL 1
Practice Address - Street 2:STONY BROOK INTERNISTS, UFPC WTC HEALTH PROGRAM
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11749-5208
Practice Address - Country:US
Practice Address - Phone:631-855-1201
Practice Address - Fax:631-630-6299
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60282020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine