Provider Demographics
NPI:1902885387
Name:ACCETTURA, JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:ACCETTURA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 ROUTE 300 STE 108
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2910
Mailing Address - Country:US
Mailing Address - Phone:845-561-0305
Mailing Address - Fax:845-561-9041
Practice Address - Street 1:1433 ROUTE 300 STE 108
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2910
Practice Address - Country:US
Practice Address - Phone:845-561-0305
Practice Address - Fax:845-561-9041
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT004377152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00875654Medicaid
NYU19291Medicare UPIN
NYA300001000Medicare PIN
NY410006185Medicare PIN