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NPI Code Detail

MEDICARE: DR. ALLAN ABRAHAM CASSORLA PH.D.

MEDICARE:  DR. ALLAN ABRAHAM CASSORLA  PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist008886-1NY

General Provider Information

NPI Number : 1396877627
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALLAN ABRAHAM CASSORLA PH.D.
Provider Business Mailing Address
First Line : 375 W END AVE
Second Line : SUITE 1D
City : NEW YORK
State : NY
Zip : 10024-6568
Country : US
Telephone Number : 212-787-4643
Fax Number :
Provider Business Practice Location Address
First Line : 375 W END AVE
Second Line : SUITE 1D
City : NEW YORK
State : NY
Zip : 10024-6568
Country : US
Telephone Number : 212-787-4643
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 07/08/2007

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