Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 035611 | NY |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 035611 | NY |
NPI | 1649214651 |
---|---|
Provider Name | Dr. Anthony J. Casino |
First Address | Centereach, NY 11720-2279 |
Second Address | Centereach, NY 11720-2279 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 19/07/2019 |