Healthcare Provider Details

I. General information

NPI: 1821082009
Provider Name (Legal Business Name): PATRICK J CARGUELLO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 DELANO ST
PULASKI NY
13142-1400
US

IV. Provider business mailing address

61 DELANO ST
PULASKI NY
13142-1400
US

V. Phone/Fax

Practice location:
  • Phone: 315-298-6569
  • Fax: 315-298-7488
Mailing address:
  • Phone: 315-298-6569
  • Fax: 315-298-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number216292
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: