Individual
DR. CHARLES JOHN VACCARIELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2092 JERICHO TPKE STE 5, COMMACK, NY 11725-3008
(631) 343-7611
(631) 343-7612
Mailing address
300 OAKWOOD DR, SOUTHOLD, NY 11971-3210
(631) 765-1104
Taxonomy
Speciality
Code
Description
License number
State
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
104837
NY
208800000X
Urology Physician
104837
NY
332900000X
Non-Pharmacy Dispensing Site
104837
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00631190
—
NY
Enumeration date
11/28/2006
Last updated
07/21/2022
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