Provider Demographics
NPI:1205006236
Name:PHILIP R. CASSAR M.D., P.C.
Entity Type:Organization
Organization Name:PHILIP R. CASSAR M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:CASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-458-6258
Mailing Address - Street 1:14 MAURICE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1843
Mailing Address - Country:US
Mailing Address - Phone:516-458-6258
Mailing Address - Fax:631-223-2271
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4893
Practice Address - Country:US
Practice Address - Phone:516-458-6258
Practice Address - Fax:631-223-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233299207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY233299OtherLICENSE
NYWXPZV1Medicare UPIN
NY1205006236Medicare PIN