Provider Demographics
NPI:1922086354
Name:VACCARINO, ROBERT ALDO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALDO
Last Name:VACCARINO
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 1:1435 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3435
Mailing Address - Country:US
Mailing Address - Phone:718-837-0010
Mailing Address - Fax:718-837-1411
Practice Address - Street 1:1435 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3435
Practice Address - Country:US
Practice Address - Phone:718-837-0010
Practice Address - Fax:718-837-1411
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170563-1207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01793324Medicaid
NYE44190Medicare UPIN
NY01793324Medicaid