Provider Demographics
NPI:1962489880
Name:CACCIARELLI, ARMAND G (MD)
Entity Type:Individual
Prefix:DR
First Name:ARMAND
Middle Name:G
Last Name:CACCIARELLI
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 1:153 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8305
Mailing Address - Country:US
Mailing Address - Phone:212-627-7638
Mailing Address - Fax:212-609-1502
Practice Address - Street 1:314 W 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-5002
Practice Address - Country:US
Practice Address - Phone:212-627-7638
Practice Address - Fax:212-604-1502
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176274207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01580854Medicaid
NY42J122Medicare ID - Type Unspecified
NY01580854Medicaid