Provider Demographics
NPI:1629153424
Name:LUCARIELLO, RALPH JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:JOSEPH
Last Name:LUCARIELLO
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 1:4234 BRONX BOULEVARD
Mailing Address - Street 2:MONTEFIORE NORTH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466
Mailing Address - Country:US
Mailing Address - Phone:718-920-9588
Mailing Address - Fax:718-920-9245
Practice Address - Street 1:4234 BRONX BOULEVARD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466
Practice Address - Country:US
Practice Address - Phone:347-341-4346
Practice Address - Fax:718-920-9245
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00094826Medicaid
B13976Medicare UPIN
NY00094826Medicaid