Provider Demographics
NPI:1013000405
Name:GASPARINI, MARK C (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:GASPARINI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4601
Mailing Address - Country:US
Mailing Address - Phone:516-804-9038
Mailing Address - Fax:516-799-2595
Practice Address - Street 1:119 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4601
Practice Address - Country:US
Practice Address - Phone:516-804-9038
Practice Address - Fax:516-799-2595
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0061141213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02744232Medicaid
NYPK3131Medicare ID - Type Unspecified
NY02744232Medicaid