Provider Demographics
NPI:1821082009
Name:CARGUELLO, PATRICK J (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:CARGUELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 DELANO ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-1400
Mailing Address - Country:US
Mailing Address - Phone:315-298-6569
Mailing Address - Fax:315-298-7488
Practice Address - Street 1:61 DELANO ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:NY
Practice Address - Zip Code:13142-1400
Practice Address - Country:US
Practice Address - Phone:315-298-6569
Practice Address - Fax:315-298-7488
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00307662Medicaid
331880OtherFQHC NUMBER
NY00216292Medicaid
NY00307662Medicaid
NYDD6904Medicare PIN
NYH21582Medicare UPIN