Provider Demographics
NPI:1235190174
Name:CASSON, IRA R (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:R
Last Name:CASSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:112-03 QUEENS BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-544-6633
Mailing Address - Fax:718-544-6670
Practice Address - Street 1:112-03 QUEENS BLVD
Practice Address - Street 2:STE 201
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-544-6633
Practice Address - Fax:718-544-6670
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2011-10-14
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Provider Licenses
StateLicense IDTaxonomies
NY1275682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A99077Medicare UPIN