Provider Demographics
NPI:1891868857
Name:CASSAR, PHILIP RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:RAYMOND
Last Name:CASSAR
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 1:1205 FRANKLIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1600
Mailing Address - Country:US
Mailing Address - Phone:516-222-0067
Mailing Address - Fax:631-223-2271
Practice Address - Street 1:1205 FRANKLIN AVE STE 150
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1600
Practice Address - Country:US
Practice Address - Phone:516-222-0067
Practice Address - Fax:631-223-2271
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233299207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01088XPZV1Medicare UPIN
NY1891868857Medicare PIN