Provider Demographics
NPI:1285744854
Name:ANDREW CARUCCI
Entity type:Organization
Organization Name:ANDREW CARUCCI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-735-2971
Mailing Address - Street 1:1600 DE PEYSTER AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5210
Mailing Address - Country:US
Mailing Address - Phone:315-735-2971
Mailing Address - Fax:315-735-2971
Practice Address - Street 1:1508 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5178
Practice Address - Country:US
Practice Address - Phone:315-735-2971
Practice Address - Fax:315-735-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02137942OtherNY MEDICAID
NY02137942OtherNY MEDICAID
NY3872470001Medicare ID - Type UnspecifiedMEDICARE