Healthcare Provider Details

I. General information

NPI: 1962777169
Provider Name (Legal Business Name): CLAIR MARY CASCELLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 NEW HYDE PARK RD STE 200
NEW HYDE PARK NY
11042-1214
US

IV. Provider business mailing address

372 LUCILLE AVE
ELMONT NY
11003-3442
US

V. Phone/Fax

Practice location:
  • Phone: 516-488-1888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number260795-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: