Healthcare Provider Details

I. General information

NPI: 1841440492
Provider Name (Legal Business Name): CYNTHIA YVONNE HOLMAN CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2367 2ND AVE
NEW YORK NY
10035-3108
US

IV. Provider business mailing address

2367 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 Code251B00000X
TaxonomyCase Management Agency
License Number17531
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: