Provider Demographics
NPI:1043206055
Name:CASSANO, LAWRENCE (DPM)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:CASSANO
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 1:1273 WILLIAM FLOYD PKWY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1810
Mailing Address - Country:US
Mailing Address - Phone:631-447-9263
Mailing Address - Fax:631-758-1904
Practice Address - Street 1:1273 WILLIAM FLOYD PKWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-1810
Practice Address - Country:US
Practice Address - Phone:631-447-9263
Practice Address - Fax:631-758-1904
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004610213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT93372Medicare UPIN
NYP51911Medicare ID - Type Unspecified