Healthcare Provider Details

I. General information

NPI: 1851395123
Provider Name (Legal Business Name): MARIO CHIARIELLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 73RD ST
BROOKLYN NY
11228-2111
US

IV. Provider business mailing address

1479 73RD ST
BROOKLYN NY
11228-2111
US

V. Phone/Fax

Practice location:
  • Phone: 718-331-4938
  • Fax: 718-621-3906
Mailing address:
  • Phone: 718-331-4938
  • Fax: 718-621-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number145387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: