Provider Demographics
NPI:1639192677
Name:NASCA, PAUL C (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:NASCA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2562 WALDEN AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4758
Mailing Address - Country:US
Mailing Address - Phone:716-683-3330
Mailing Address - Fax:716-683-7759
Practice Address - Street 1:2562 WALDEN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4758
Practice Address - Country:US
Practice Address - Phone:716-683-3330
Practice Address - Fax:716-683-7759
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0036331213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0485380001Medicare NSC