Provider Demographics
NPI:1821097742
Name:CASSIMATIS, DEAN NICK (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:NICK
Last Name:CASSIMATIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COATES DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6758
Mailing Address - Country:US
Mailing Address - Phone:845-651-1400
Mailing Address - Fax:845-651-1512
Practice Address - Street 1:277 QUASSAICK AVE
Practice Address - Street 2:RT. 94
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7632
Practice Address - Country:US
Practice Address - Phone:845-565-5630
Practice Address - Fax:845-565-5643
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175299207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A400029609OtherMEDICARE
NY01233398Medicaid
A400029609OtherMEDICARE