Provider Demographics
NPI:1063407898
Name:CAIATI, PAUL JOHN (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JOHN
Last Name:CAIATI
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 1:373 RTE 111
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4759
Mailing Address - Country:US
Mailing Address - Phone:631-265-0050
Mailing Address - Fax:631-265-0204
Practice Address - Street 1:373 ROUTE 111
Practice Address - Street 2:SUITE 14
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4759
Practice Address - Country:US
Practice Address - Phone:631-265-0050
Practice Address - Fax:631-265-0204
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0C5172OtherHEALTHNET
CP283OtherOXFORD
110032024OtherRAILROAD MEDICARE
VYTIAOther10142
NY01027292Medicaid
AH46646OtherMDNY
110032024OtherRAILROAD MEDICARE
CP283OtherOXFORD