Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N004610 | NY |
Y | 222Z00000X | Podiatrist | N004610 | NY |
NPI | 1043206055 |
---|---|
Provider Name | Lawrence Cassano |
First Address | Shirley, NY 11967-1810 |
Second Address | Shirley, NY 11967-1810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 04/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T93372 | (02) | NY |