Provider Demographics
NPI:1992045769
Name:DOMENIC P AIELLO, MD
Entity type:Organization
Organization Name:DOMENIC P AIELLO, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMENIC
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:AIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-732-3300
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-0010
Mailing Address - Country:US
Mailing Address - Phone:315-732-3300
Mailing Address - Fax:315-732-0730
Practice Address - Street 1:1 OXFORD XING
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-3200
Practice Address - Country:US
Practice Address - Phone:315-732-3300
Practice Address - Fax:315-732-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157472207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01297589Medicaid
NY01297589Medicaid