Healthcare Provider Details

I. General information

NPI: 1477570323
Provider Name (Legal Business Name): JEROME ABELLANA CARIASO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 BERGEN AVE FL 1
BRONX NY
10455-4010
US

IV. Provider business mailing address

141 ROCKY MOUNTAIN RD
SOUTHBURY CT
06488-2727
US

V. Phone/Fax

Practice location:
  • Phone: 718-742-8550
  • Fax: 718-742-7321
Mailing address:
  • Phone: 646-481-6488
  • Fax: 212-656-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number215615
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: