Provider Demographics
NPI:1255428181
Name:CACCIATORE, JOSEPH CARMINE (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CARMINE
Last Name:CACCIATORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 SOUTH OCEAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520
Mailing Address - Country:US
Mailing Address - Phone:516-546-1344
Mailing Address - Fax:516-546-1344
Practice Address - Street 1:325 SOUTH OCEAN AVENUE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520
Practice Address - Country:US
Practice Address - Phone:516-546-1344
Practice Address - Fax:516-546-1344
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYICX10973Medicare UPIN
NYT51913Medicare PIN