Provider Demographics
NPI:1740254937
Name:BISACCO, JOHN FRANCIS (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FRANCIS
Last Name:BISACCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 WATER ST
Mailing Address - Street 2:12TH FLOOR CREDENTIALING
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:300 BAY SHORE RD
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-2823
Practice Address - Country:US
Practice Address - Phone:631-586-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1625261208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00944821Medicaid
NYA400160422Medicare PIN
B19338Medicare UPIN