Individual
DR. GUSTAVO A. CARDENAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
74 E WOODSIDE AVE, PATCHOGUE, NY 11772-1314
(631) 654-1749
(631) 654-1790
Mailing address
74 E WOODSIDE AVE, PATCHOGUE, NY 11772-1314
(631) 654-1749
(631) 654-1790
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
112984
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0082356
GHI
NY
01
—
1000015665
AFFINITY
NY
01
—
11-2432871
TAX ID
NY
01
—
20502
AETNA
NY
01
—
226752P
HIP
NY
01
—
2375
VYTRA
NY
01
—
431247
UNITED HEALTHCARE
NY
01
—
P1233307
OXFORD FREEDOM PLAN
NY
Enumeration date
01/06/2007
Last updated
10/25/2013
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