MEDICARE: DR. MICHAEL F PACCIONE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0102X	Surgical Critical Care Physician	219771	NY
2	208600000X	Surgery Physician	219771	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	500H51	OTHER	NY	EMPIRE BC.BS
3	7990737	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1760401103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL F PACCIONE M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 1559
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 RESEARCH WAY
Second Line	:
City	:	EAST SETAUKET
State	:	NY
Zip	:	11733
Country	:	US
Telephone Number	:	631-444-4545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	05/11/2026

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