Provider Demographics
NPI:1992703391
Name:CARASCA, ANDREI (MD)
Entity type:Individual
Prefix:
First Name:ANDREI
Middle Name:
Last Name:CARASCA
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 1:875 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4952
Mailing Address - Country:US
Mailing Address - Phone:212-288-4181
Mailing Address - Fax:212-288-4011
Practice Address - Street 1:875 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4952
Practice Address - Country:US
Practice Address - Phone:212-288-4181
Practice Address - Fax:212-288-4011
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2011-08-10
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
NY1960962084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG22945Medicare UPIN
NY505881Medicare ID - Type Unspecified