Healthcare Provider Details

I. General information

NPI: 1245274323
Provider Name (Legal Business Name): MARK A CASELLI D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 ALBANY POST RD. ROUTE 9 A VA HUDSON VALLEY HEALTH CARE SYSTEM MONTROSE CAMPUS
MONTROSE NY
10548
US

IV. Provider business mailing address

294 E CRESCENT AVE
RAMSEY NJ
07446-2004
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax: 914-788-4274
Mailing address:
  • Phone: 201-825-3692
  • Fax: 201-825-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN2599
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: