Provider Demographics
NPI:1740328277
Name:CANCELLIERI, CARMELA R (MD)
Entity type:Individual
Prefix:DR
First Name:CARMELA
Middle Name:R
Last Name:CANCELLIERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 DRISLER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-2402
Mailing Address - Country:US
Mailing Address - Phone:914-324-2372
Mailing Address - Fax:
Practice Address - Street 1:1 STONE PL
Practice Address - Street 2:SUITE 302
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3426
Practice Address - Country:US
Practice Address - Phone:914-337-0754
Practice Address - Fax:914-337-6493
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1419422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00901455Medicaid
NY0099878OtherGHI (GROUP HEALTH INS)
73289510OtherVALUE OPTIONS
73289510OtherVALUE OPTIONS
C06715Medicare UPIN