Provider Demographics
NPI:1548229537
Name:CANNATA, CARL F (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:F
Last Name:CANNATA
Suffix:
Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:41 CABOT RD W
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-8026
Mailing Address - Country:US
Mailing Address - Phone:516-799-5255
Mailing Address - Fax:
Practice Address - Street 1:79 MIDDLEVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2200
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:631-544-5308
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY000282-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical