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General NPI Number Information
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NPI Number | 1124844980
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Entity Type | Individual
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Provider Name | CASEY RANDLOV NP
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Gender | Female
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 1 PENN PLZ FL 8
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City | NEW YORK
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State | NY
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Zip | 10119-0899
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Country | US
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Telephone | 866-234-8913
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Fax |
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Provider Business Mailing Address
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Address Line | 40 CAMPBELL LN
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City | EAST ISLIP
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State | NY
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Zip | 11730-3621
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Country | US
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Telephone | 631-357-6398
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | F311881-01
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License Number State | NY
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