Provider Demographics
NPI:1619927084
Name:CASSETTA, ROCCO G (PA)
Entity Type:Individual
Prefix:
First Name:ROCCO
Middle Name:G
Last Name:CASSETTA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WENLISS TER
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-2714
Mailing Address - Country:US
Mailing Address - Phone:845-874-8687
Mailing Address - Fax:
Practice Address - Street 1:39 WENLISS TER
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-2714
Practice Address - Country:US
Practice Address - Phone:845-874-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008014-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P50859Medicare UPIN
NJ097854Medicare ID - Type Unspecified