Provider Demographics
NPI:1144376880
Name:MAURO GASPARINI, M.D., P.C.
Entity Type:Organization
Organization Name:MAURO GASPARINI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURO
Authorized Official - Middle Name:D
Authorized Official - Last Name:GASPARINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-799-2555
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:516-799-2555
Mailing Address - Fax:
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:516-799-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00591460Medicaid
NY00591460Medicaid
NYWYYQT1Medicare PIN