Provider Demographics
NPI:1477570323
Name:CARIASO, JEROME ABELLANA (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ABELLANA
Last Name:CARIASO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:141 ROCKY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2727
Mailing Address - Country:US
Mailing Address - Phone:646-481-6488
Mailing Address - Fax:212-656-1601
Practice Address - Street 1:1075 BROADWAY
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2346
Practice Address - Country:US
Practice Address - Phone:845-743-6703
Practice Address - Fax:579-977-1023
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2025-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY215615208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03070826Medicaid
NY03070826Medicaid