Basic Information
| Provider Information | |||||||||
| NPI: | 1386620631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IACOBELLIS | ||||||||
| FirstName: | FRANCIS | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 SOUTHHALL LN STE 300 | ||||||||
| Address2: | |||||||||
| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327517172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078752080 | ||||||||
| FaxNumber: | 0765034554 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 E 63RD ST UNIT 1BC | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100657302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126613376 | ||||||||
| FaxNumber: | 2126613366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 04/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 114091-1 | NY | Y | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | ME132341 | FL | N | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 133884168 | 01 | NY | HORIZON HEALTHCARE OF NY | OTHER | 2132222 | 01 | NY | AETNA HMO | OTHER | 4220508 | 01 | NY | AETNA NON HMO | OTHER | 133884168 | 01 | NY | EMPIRE STATE PLAN (NYS) | OTHER | 3C1366 | 01 | NY | HEALTHNET | OTHER | 133884168 | 01 | NY | BEECH STREET | OTHER | 13U231 | 01 | NY | BLUE CROSS HMO | OTHER | P942741 | 01 | NY | OXFORD | OTHER | 133884168 | 01 | NY | MULTIPLAN | OTHER | 0250055 | 05 | NY | MEDICAID | 114019 | 01 | NY | CONNECTICARE | OTHER | 317283 | 01 | NY | BLUE CROSS PPO | OTHER | 000000045835 | 01 | NY | GHI HMO | OTHER | 696790 | 01 | NY | PHCS | OTHER | 133884168 | 01 | NY | POMCO | OTHER | 070011868 | 01 | NY | RAILROAD MEDICARE | OTHER | 133884168 | 01 | NY | UNITED HEALTH CARE | OTHER | 173187P | 01 | NY | HIP | OTHER |