Provider Demographics
NPI:1447292578
Name:MONTOYA-IRAHETA, CARLOS H (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:H
Last Name:MONTOYA-IRAHETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:222 STATION PLZ N
Mailing Address - Street 2:SUITE 611
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3808
Mailing Address - Country:US
Mailing Address - Phone:516-663-2532
Mailing Address - Fax:516-663-2233
Practice Address - Street 1:120 MINEOLA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4073
Practice Address - Country:US
Practice Address - Phone:516-663-4600
Practice Address - Fax:516-663-4473
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1889082080P0202X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01344747Medicaid
NY01344747Medicaid