Provider Demographics
NPI:1356565519
Name:CANARIO, JOSE R JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:CANARIO
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-0423
Mailing Address - Country:US
Mailing Address - Phone:315-531-9102
Mailing Address - Fax:315-531-9103
Practice Address - Street 1:7150 MAIN ST
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:NY
Practice Address - Zip Code:14521-9401
Practice Address - Country:US
Practice Address - Phone:607-403-0065
Practice Address - Fax:607-403-0093
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2017-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY243042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02866879Medicaid
NY243042OtherLICENSE
NY02866879Medicaid