Provider Demographics
NPI:1568534709
Name:CASABIANCA KYROU DPM PC
Entity Type:Organization
Organization Name:CASABIANCA KYROU DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CASABIANCA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-227-6947
Mailing Address - Street 1:1007 ROUTE 82
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6165
Mailing Address - Country:US
Mailing Address - Phone:845-227-6947
Mailing Address - Fax:845-227-6729
Practice Address - Street 1:1007 ROUTE 82
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-6165
Practice Address - Country:US
Practice Address - Phone:845-227-6947
Practice Address - Fax:845-227-6729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPSW962Medicare PIN
NY5343440001Medicare NSC
NYPSW961Medicare PIN
NYPSW963Medicare PIN