Individual
DOMINICK J CARILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 PARK ST, GLENS FALLS HOSPITAL, GLENS FALLS, NY 12801-4413
(518) 926-3000
(518) 926-3127
Mailing address
100 PARK ST, GLENS FALLS HOSPITAL - CREDENTIALING, GLENS FALLS, NY 12801-4413
(518) 926-5100
(518) 926-6983
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
189110
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70021A
MEDICARE PART B
—
Enumeration date
11/22/2006
Last updated
05/05/2017
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