Provider Demographics
NPI:1346216124
Name:CARROCCIO, ALFIO (MD)
Entity Type:Individual
Prefix:
First Name:ALFIO
Middle Name:
Last Name:CARROCCIO
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 1:130 E 77TH ST FL 13
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1851
Mailing Address - Country:US
Mailing Address - Phone:212-434-3420
Mailing Address - Fax:212-434-3410
Practice Address - Street 1:130 E 77TH ST FL 13
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1851
Practice Address - Country:US
Practice Address - Phone:212-434-3420
Practice Address - Fax:212-434-3410
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207247208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02207303Medicaid
H51920Medicare UPIN
NY1310H1Medicare ID - Type Unspecified