Provider Demographics
NPI:1639162118
Name:CASINOVER-RAIO, DENISE G (DPM)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:G
Last Name:CASINOVER-RAIO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:CASINOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1032 FORT SALONGA RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2208
Mailing Address - Country:US
Mailing Address - Phone:631-754-3338
Mailing Address - Fax:631-754-3367
Practice Address - Street 1:1032 FORT SALONGA RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2208
Practice Address - Country:US
Practice Address - Phone:631-754-3338
Practice Address - Fax:631-754-3367
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005219213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01573528Medicaid
NYP92251Medicare PIN
U57197Medicare UPIN