Provider Demographics
NPI:1396763926
Name:LUCARIELLO, RICHARD JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSEPH
Last Name:LUCARIELLO
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:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-0413
Mailing Address - Country:US
Mailing Address - Phone:718-920-9074
Mailing Address - Fax:718-920-6849
Practice Address - Street 1:600 E 233RD ST
Practice Address - Street 2:CARDIOLOGY DEPT.
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2604
Practice Address - Country:US
Practice Address - Phone:718-920-9256
Practice Address - Fax:718-920-6849
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164932207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01140638Medicaid
NY25F572Medicare ID - Type Unspecified
NY01140638Medicaid