Provider Demographics
NPI:1932269289
Name:CAIATI, JEROME R (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:R
Last Name:CAIATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11571-0198
Mailing Address - Country:US
Mailing Address - Phone:516-764-6605
Mailing Address - Fax:516-764-6243
Practice Address - Street 1:165 N VILLAGE AVE STE 134
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3763
Practice Address - Country:US
Practice Address - Phone:516-764-6605
Practice Address - Fax:516-764-6243
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1438231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTAX ID#451875841OtherTAX ID
NY02023307Medicaid
NY02023307Medicaid
NYTAX ID#451875841OtherTAX ID