Provider Demographics
NPI:1912018904
Name:CASSARA, LOUIS VINCENT
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:VINCENT
Last Name:CASSARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-2326
Mailing Address - Country:US
Mailing Address - Phone:631-288-4345
Mailing Address - Fax:631-288-4363
Practice Address - Street 1:58 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2326
Practice Address - Country:US
Practice Address - Phone:631-288-4345
Practice Address - Fax:631-288-4363
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039472-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02588094Medicaid
NY5240990001Medicare NSC