Provider Demographics
NPI:1699864132
Name:PACELLA, BERNARD L JR (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:L
Last Name:PACELLA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2002
Mailing Address - Country:US
Mailing Address - Phone:631-882-4025
Mailing Address - Fax:631-657-5456
Practice Address - Street 1:115 E 61ST ST APT 4C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8184
Practice Address - Country:US
Practice Address - Phone:212-486-5000
Practice Address - Fax:631-657-5456
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY195401-1207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY32J991Medicare ID - Type Unspecified