Provider Demographics
NPI:1164567376
Name:CAVAGNARO, JOHN A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:CAVAGNARO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4295 HEMPSTEAD TURNPIKE
Mailing Address - Street 2:DEPARTMENT CRITICAL CARE MEDICINE
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714
Mailing Address - Country:US
Mailing Address - Phone:516-520-2387
Mailing Address - Fax:
Practice Address - Street 1:4295 HEMPSTEAD TURNPIKE
Practice Address - Street 2:CRITICAL CARE MEDICNE
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-579-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011726363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical