Provider Demographics
NPI:1477570323
Name:CARIASO, JEROME ABELLANA (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ABELLANA
Last Name:CARIASO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:141 ROCKY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2727
Mailing Address - Country:US
Mailing Address - Phone:212-234-1112
Mailing Address - Fax:646-688-2333
Practice Address - Street 1:2366 ADAM CLAYTON POWELL JR BLVD
Practice Address - Street 2:FRONT 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2219
Practice Address - Country:US
Practice Address - Phone:212-234-1112
Practice Address - Fax:646-688-2333
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY215615208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03070826Medicaid
NY03070826Medicaid