Provider Demographics
NPI:1437217940
Name:CONIGLIARO, JOSEPH DONALD (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DONALD
Last Name:CONIGLIARO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOHAWK
Mailing Address - State:NY
Mailing Address - Zip Code:13407
Mailing Address - Country:US
Mailing Address - Phone:315-866-6070
Mailing Address - Fax:315-866-7122
Practice Address - Street 1:127 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOHAWK
Practice Address - State:NY
Practice Address - Zip Code:13407
Practice Address - Country:US
Practice Address - Phone:315-866-6070
Practice Address - Fax:315-866-7122
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0038571152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00551446Medicaid
T26544Medicare UPIN
NY00551446Medicaid
MA0165630001Medicare NSC