Provider Demographics
NPI:1437248762
Name:PACCIONE, GERALD A (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:A
Last Name:PACCIONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CARMINE ST
Mailing Address - Street 2:APT. 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4426
Mailing Address - Country:US
Mailing Address - Phone:718-920-6738
Mailing Address - Fax:718-920-8375
Practice Address - Street 1:MMC - DEPT. OF MEDICINE
Practice Address - Street 2:111 E. 210TH STREET, CENT. 3
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-6738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine