Healthcare Provider Details

I. General information

NPI: 1598982944
Provider Name (Legal Business Name): LEO CAAMANO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GRACE CHURCH ST
PORT CHESTER NY
10573-4911
US

IV. Provider business mailing address

165 MAIN ST
OSSINING NY
10562-4702
US

V. Phone/Fax

Practice location:
  • Phone: 914-937-8899
  • Fax: 914-937-7932
Mailing address:
  • Phone: 914-502-1470
  • Fax: 914-941-0993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011136-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: