Provider Demographics
NPI:1841500469
Name:RUBEN U. CARVAJAL MDPC
Entity type:Organization
Organization Name:RUBEN U. CARVAJAL MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:U
Authorized Official - Last Name:CARVAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-733-2621
Mailing Address - Street 1:2271 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-6905
Mailing Address - Country:US
Mailing Address - Phone:718-733-2621
Mailing Address - Fax:718-733-3839
Practice Address - Street 1:2271 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6905
Practice Address - Country:US
Practice Address - Phone:718-733-2621
Practice Address - Fax:718-733-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-16
Last Update Date:2010-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150807261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00812102Medicaid
NYA60522Medicare UPIN