MEDICARE: JOHN A CARUCCI MD

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	207ND0101X	MOHS-Micrographic Surgery Physician	202425	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

General Provider Information

NPI Number	:	1265520530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A CARUCCI MD

Provider Business Mailing Address
First Line	:	969 MAIN ST STE D
Second Line	:
City	:	FISHKILL
State	:	NY
Zip	:	12524-1791
Country	:	US
Telephone Number	:	845-896-7730
Fax Number	:	845-896-7758

Provider Business Practice Location Address
First Line	:	969 MAIN ST STE D
Second Line	:
City	:	FISHKILL
State	:	NY
Zip	:	12524-1791
Country	:	US
Telephone Number	:	845-896-7730
Fax Number	:	845-896-7758

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	03/18/2026

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