Provider Demographics
NPI:1578548459
Name:PICCORELLI, GEORGE OLIVER (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:OLIVER
Last Name:PICCORELLI
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 1:3030 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2574
Mailing Address - Country:US
Mailing Address - Phone:914-848-8750
Mailing Address - Fax:914-848-8751
Practice Address - Street 1:3030 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2574
Practice Address - Country:US
Practice Address - Phone:914-848-8750
Practice Address - Fax:914-848-8751
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1542452086S0129X
CT0436392086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00199903Medicaid
NY36E402L683Medicare PIN
NYA62527Medicare UPIN