Provider Demographics
NPI:1114101615
Name:CASSIDY, MARY ELLEN (PA)
Entity Type:Individual
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First Name:MARY ELLEN
Middle Name:
Last Name:CASSIDY
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Gender:F
Credentials:PA
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Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2354
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:935 NORTHERN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5316
Practice Address - Country:US
Practice Address - Phone:516-466-9062
Practice Address - Fax:516-466-9081
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2009-11-12
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Provider Licenses
StateLicense IDTaxonomies
NY002298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant