Healthcare Provider Details

I. General information

NPI: 1427740307
Provider Name (Legal Business Name): CASEY LORRAINE GILLIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 W 16TH ST APT 1C
NEW YORK NY
10011-5931
US

IV. Provider business mailing address

347 W 16TH ST APT 1C
NEW YORK NY
10011-5931
US

V. Phone/Fax

Practice location:
  • Phone: 303-883-0207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number031750
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9117654
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: