| Annette Racaniello D O P C | |
|
1 Andiron Ln Brookhaven NY 11719-9534 | |
| (631) 286-2355 | |
| (631) 286-6808 |
| Full Name | Annette Racaniello D O P C |
|---|---|
| Speciality | Family Medicine |
| Location | 1 Andiron Ln, Brookhaven, New York |
| Authorized Official Name and Position | Nancy Racaniello (OFFICE MANAGER) |
| Authorized Official Contact | 6312862355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Annette Racaniello D O P C Po Box 78 Brookhaven NY 11719-0078 Ph: (631) 286-2355 | Annette Racaniello D O P C 1 Andiron Ln Brookhaven NY 11719-9534 Ph: (631) 286-2355 |
| NPI Number | 1700020260 |
|---|---|
| Provider Enumeration Date | 04/28/2009 |
| Last Update Date | 07/07/2010 |
| Medicare PECOS PAC ID | 4385775063 |
|---|---|
| Medicare Enrollment ID | O20100624000108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700020260 | NPI | - | NPPES |
| 01153048 | Medicaid | NY | |
| 03197073 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 157578 (New York) | Primary |
| Provider Name | Annette F Racaniello |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134116387 PECOS PAC ID: 5193856888 Enrollment ID: I20100624000138 |
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