Provider Demographics
NPI:1144438128
Name:PARILLO, JACK P (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:P
Last Name:PARILLO
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 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-677-3961
Mailing Address - Fax:518-677-3180
Practice Address - Street 1:35 GILBERT ST
Practice Address - Street 2:CAMBRIDGE FAMILY HEALTH CENTER
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816-2618
Practice Address - Country:US
Practice Address - Phone:518-677-3961
Practice Address - Fax:518-677-3180
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145074-1207RC0200X
NY145074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10017565OtherCDPHP
NY91032OtherMVP
NY000462005001OtherSENIOR BLUE
NY00650266Medicaid
NY145074AOtherPREFERRED CARE
NY68E431OtherBLUE CROSS
NY91032OtherMVP
NY68E431OtherBLUE CROSS
NYJ400019576Medicare PIN