Provider Demographics
NPI:1497848899
Name:JUANITO CAGUIAT JR PHYSICIAN, PLLC
Entity Type:Organization
Organization Name:JUANITO CAGUIAT JR PHYSICIAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUANITO
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAGUIAT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:718-850-1320
Mailing Address - Street 1:153 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1103
Mailing Address - Country:US
Mailing Address - Phone:516-625-2789
Mailing Address - Fax:516-625-2789
Practice Address - Street 1:9303 90TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2751
Practice Address - Country:US
Practice Address - Phone:718-850-1320
Practice Address - Fax:718-850-6087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188263207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY901231302OtherAMERICHOICE
NY167825OtherELDERPLAN
NY01481185Medicaid
NY2516088OtherGHI
NY31-00573OtherUHC
NY4C5829OtherHEALTHNET
NY3943046OtherAETNA
NYP638639OtherOXFORD
NY227600OtherWELLCARE
NYP638639OtherOXFORD
NY3943046OtherAETNA
NY4C5829OtherHEALTHNET