Provider Demographics
NPI:1679547111
Name:AIELLO, DOMENIC P (MD)
Entity type:Individual
Prefix:
First Name:DOMENIC
Middle Name:P
Last Name:AIELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Mailing Address - Country:US
Mailing Address - Phone:315-732-3300
Mailing Address - Fax:315-732-0730
Practice Address - Street 1:1 OXFORD CROSSING
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157472207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01297589Medicaid
NY01297589Medicaid
E15721Medicare UPIN