Healthcare Provider Details

I. General information

NPI: 1265520530
Provider Name (Legal Business Name): JOHN A CARUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 MAIN ST STE D
FISHKILL NY
12524-1791
US

IV. Provider business mailing address

969 MAIN ST STE D
FISHKILL NY
12524-1791
US

V. Phone/Fax

Practice location:
  • Phone: 845-896-7730
  • Fax: 845-896-7758
Mailing address:
  • Phone: 845-896-7730
  • Fax: 845-896-7758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number202425
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: