Provider Demographics
NPI:1386719425
Name:RONALD R BRANCACCIO MD & PETER SAITTA DO PC
Entity type:Organization
Organization Name:RONALD R BRANCACCIO MD & PETER SAITTA DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRANCACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-491-5800
Mailing Address - Street 1:7901 4TH AVENUE
Mailing Address - Street 2:APT A20
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3957
Mailing Address - Country:US
Mailing Address - Phone:718-491-5800
Mailing Address - Fax:718-748-2151
Practice Address - Street 1:7901 4TH AVENUE
Practice Address - Street 2:APT A20
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3957
Practice Address - Country:US
Practice Address - Phone:718-491-5800
Practice Address - Fax:718-748-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122348207N00000X
NY210799207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
37X941Medicare ID - Type UnspecifiedAMY E GOLDSTEIN DO
5336L1Medicare ID - Type UnspecifiedLENA LANGER PA
315031Medicare ID - Type Unspecified
B12792Medicare UPIN
G56435Medicare UPIN