Provider Demographics
NPI:1528051869
Name:APICELLA, EDWARD A (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:APICELLA
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 1:12 CORPORATE WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2524
Mailing Address - Country:US
Mailing Address - Phone:518-463-0171
Mailing Address - Fax:518-463-0174
Practice Address - Street 1:12 CORPORATE WOODS BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211-2524
Practice Address - Country:US
Practice Address - Phone:518-463-0171
Practice Address - Fax:518-463-0174
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191595207LP2900X, 208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01565035Medicaid
NY5403572OtherAETNA
NY000405461007OtherBSNENY
NY05641OtherMVP
NY10000049OtherCDPHP
NY4868OtherCDPHP GROUP #
NYEA03087930OtherEMPIRE/ BLUE CHOICE
NY110586100OtherDEPT OF LABOR/POSTAL WORK
NY141806863OtherUNITED HEALTH CARE
NY5508704OtherGHI PPO GROUP NUMBER
NY050078269OtherRAIL ROAD MEDICARE
NY5301566OtherGHI PPO DR. APICELLA'S #
NYG04192Medicare UPIN
NYCC0430Medicare ID - Type UnspecifiedDR. APICELLA'S NUMBER
NY050078269OtherRAIL ROAD MEDICARE