Individual provider Active NPI

Stacey A Cacciola, D.O.

  • Pediatrics Physician
  • Brooklyn, NY
National Provider Identifier
1407807936
Registry record updated Dec 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
229060 Issued in NY
Practice address
168 Van Brunt Street
Brooklyn, NY 11231
Phone
(917) 736-9900
NPI assigned
May 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 229060 NY Primary

Addresses

Primary practice location

168 Van Brunt Street
Brooklyn, NY 11231

Mailing address

60 Madison Ave FL 5
New York, NY 10010-1600
Phone (212) 545-2439

Other identifiers 1

IdentifierTypeStateIssuer
03040613MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120413000258 NY Practitioner - Pediatric Medicine 1850552175 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
NYU Langone Hospitals CurrentSince Aug 30, 2024 Accepting new patients
NYU Langone Hospitals CurrentSince Aug 30, 2024 Accepting new patients
New York University Pediatrics CurrentSince Jan 9, 2017 Accepting new patients
Coney Island Medical Practice Plan, P.C. CurrentSince Apr 2, 2012 Accepting new patients
NYU Langone Hospitals Current Accepting new patients
New York University CurrentSince Jan 9, 2017 Accepting new patients

Locations

700 Hicksville Rd
Ste 205
Bethpage, NY 11714
Phone (646) 501-3325

150 55th St
Brooklyn, NY 11220
Phone (718) 630-7185

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

301 E 17th St
New York, NY 10003
Phone (212) 460-0125

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: scacciola130477@nyumc.direct-ci.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765152000000",
    "number": "1407807936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MADISON AVE FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100101600",
            "telephone_number": "212-545-2439",
            "fax_number": "646-312-0481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "168 VAN BRUNT STREET",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11231",
            "telephone_number": "917-736-9900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CACCIOLA",
        "first_name": "STACEY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "229060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03040613",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.