Provider Demographics
NPI:1538436068
Name:CARRASQUILLO, ANGELO
Entity type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EXECUTIVE BLVD
Mailing Address - Street 2:1ST FL
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6822
Mailing Address - Country:US
Mailing Address - Phone:914-377-1854
Mailing Address - Fax:914-376-9859
Practice Address - Street 1:1 EXECUTIVE BLVD
Practice Address - Street 2:1ST FL
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6822
Practice Address - Country:US
Practice Address - Phone:914-377-1854
Practice Address - Fax:914-376-9859
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator