Healthcare Provider Details

I. General information

NPI: 1639162118
Provider Name (Legal Business Name): DENISE G CASINOVER-RAIO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DENISE CASINOVER

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 FORT SALONGA RD
NORTHPORT NY
11768-2208
US

IV. Provider business mailing address

1032 FORT SALONGA RD
NORTHPORT NY
11768-2208
US

V. Phone/Fax

Practice location:
  • Phone: 631-754-3338
  • Fax: 631-754-3367
Mailing address:
  • Phone: 631-754-3338
  • Fax: 631-754-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005219
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: