MEDICARE: DR. ARMAND G CACCIARELLI 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	207RG0100X	Gastroenterology Physician	176274	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	:	1962489880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARMAND G CACCIARELLI MD

Provider Business Mailing Address
First Line	:	153 W 11TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-8305
Country	:	US
Telephone Number	:	212-627-7638
Fax Number	:	212-609-1502

Provider Business Practice Location Address
First Line	:	314 W 14TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-5002
Country	:	US
Telephone Number	:	212-627-7638
Fax Number	:	212-604-1502

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	04/17/2019

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