Provider Demographics
NPI:1336116037
Name:CASSETTA, BRIAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:CASSETTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:31 ARNOT RD
Practice Address - Street 2:SUITE A
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8533
Practice Address - Country:US
Practice Address - Phone:607-739-3874
Practice Address - Fax:607-739-3632
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028026E207R00000X
NY153836-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110223749OtherRR MEDICARE PIN
PA0010878490001Medicaid
NY01028899Medicaid
NYCC8362OtherRR MEDICARE GROUP
NY110223749OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP