Provider Demographics
NPI:1336406727
Name:JEROME R CAIATI MD.,PC.
Entity Type:Organization
Organization Name:JEROME R CAIATI MD.,PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CAIATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-764-6605
Mailing Address - Street 1:165 N. VILLAGE AVE
Mailing Address - Street 2:SUITE134
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-764-6605
Mailing Address - Fax:516-764-6243
Practice Address - Street 1:165 N VILLAGE AVE
Practice Address - Street 2:SUITE#134
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-764-6605
Practice Address - Fax:516-764-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02023307Medicaid
NY79A852Medicare PIN
NYB19372Medicare UPIN