Provider Demographics
NPI:1871686691
Name:GASPARINI, MAURO D (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURO
Middle Name:D
Last Name:GASPARINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:119 NEW YORK AVENUE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4601
Mailing Address - Country:US
Mailing Address - Phone:516-799-2555
Mailing Address - Fax:516-799-2595
Practice Address - Street 1:119 NEW YORK AVENUE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4601
Practice Address - Country:US
Practice Address - Phone:516-799-2555
Practice Address - Fax:516-799-2595
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY141648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00591460Medicaid
B14294Medicare UPIN
NY00591460Medicaid