Provider Demographics
NPI:1255622759
Name:CIARLO, JACQUE (DO)
Entity type:Individual
Prefix:
First Name:JACQUE
Middle Name:
Last Name:CIARLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 95TH ST
Mailing Address - Street 2:APARTMENT 25 C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4014
Mailing Address - Country:US
Mailing Address - Phone:203-565-9361
Mailing Address - Fax:
Practice Address - Street 1:205 E 95TH ST
Practice Address - Street 2:APARTMENT 25 C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4014
Practice Address - Country:US
Practice Address - Phone:203-565-9361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9441207P00000X
CT054026207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine