Provider Demographics
NPI:1962456392
Name:IACONO, ALDO T (MD)
Entity Type:Individual
Prefix:DR
First Name:ALDO
Middle Name:T
Last Name:IACONO
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 1:410 LAKEVILLE ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-465-5417
Mailing Address - Fax:516-465-5392
Practice Address - Street 1:410 LAKEVILLE ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-465-5417
Practice Address - Fax:516-465-5392
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62655207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1962456392Medicaid
MDS062-0256OtherCAREFIRST BC/BS
MD406952800Medicaid
DC054292100Medicaid
MD645699-01OtherBLUE CROSS/BLUE SHIELD
MDS062-0256OtherCAREFIRST BC/BS
DE1962456392Medicaid
MD406952800Medicaid