Healthcare Provider Details

I. General information

NPI: 1720239627
Provider Name (Legal Business Name): PETER NEWLAND CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2369 2ND AVE
NEW YORK NY
10035
US

IV. Provider business mailing address

2369 2ND AVE
NEW YORK NY
10035-3108
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-2300
  • Fax: 212-722-7618
Mailing address:
  • Phone: 212-876-2300
  • Fax: 212-722-7618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number7308
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: