Charles John Vaccariello, MD

Primary specialty

Obesity Medicine (Family Medicine) PhysicianTaxonomy code 207QB0002X

License

104837 Issued in NY

Practice address

2092 Jericho Tpke Ste 5
Commack, NY 11725-3008

Phone

(631) 343-7611

Fax

(631) 343-7612

NPI assigned

Nov 28, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1932275963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 OAKWOOD DR",
            "city": "SOUTHOLD",
            "state": "NY",
            "postal_code": "119713210",
            "telephone_number": "631-765-1104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2092 JERICHO TPKE STE 5",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117253008",
            "telephone_number": "631-343-7611",
            "fax_number": "631-343-7612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VACCARIELLO",
        "first_name": "CHARLES",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "104837",
            "primary": false
        },
        {
            "code": "207QB0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Obesity Medicine",
            "state": "NY",
            "license": "104837",
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NY",
            "license": "104837",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00631190",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Amy Uthup
• Shawn Uthup
• V.P. Kid Services Inc.
• Michaella Vagelatos
• Caryn E Valencia, NPP
• Corrine Nicole Valenti
• Christine Valeri, M.S
• Gary Valevich, PHARMD

• Obesity Medicine (Family Medicine) Physician in Commack, NY
• Providers in Commack, NY by specialty
• Obesity Medicine (Family Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.