Provider Demographics
NPI:1265673495
Name:DR MIRIAM N CASAL M D P C
Entity Type:Organization
Organization Name:DR MIRIAM N CASAL M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-803-3000
Mailing Address - Street 1:37-42 ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:718-803-3000
Mailing Address - Fax:775-243-5227
Practice Address - Street 1:37-42 ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-803-3000
Practice Address - Fax:775-243-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183943207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty