Provider Demographics
NPI:1114020690
Name:CARDIELLO, GARY P (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:P
Last Name:CARDIELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:744 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002
Mailing Address - Country:US
Mailing Address - Phone:201-436-8888
Mailing Address - Fax:201-436-6644
Practice Address - Street 1:206 BERGEN AVE STE 201
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3386
Practice Address - Country:US
Practice Address - Phone:201-948-5879
Practice Address - Fax:201-628-2651
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04592300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C62892Medicare UPIN