Provider Demographics
NPI:1487210266
Name:CASCO, JAN MARK (MT-BC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:MARK
Last Name:CASCO
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3326
Mailing Address - Country:US
Mailing Address - Phone:516-547-6553
Mailing Address - Fax:
Practice Address - Street 1:210 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3326
Practice Address - Country:US
Practice Address - Phone:516-547-6553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14618225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist