Provider Demographics
NPI:1942469622
Name:CASASANTA, KRISTIN LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LEIGH
Last Name:CASASANTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3741
Mailing Address - Country:US
Mailing Address - Phone:914-777-5437
Mailing Address - Fax:914-630-0907
Practice Address - Street 1:620 E BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3741
Practice Address - Country:US
Practice Address - Phone:914-777-5437
Practice Address - Fax:914-630-0907
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD71927208000000X
NY281956208000000X
CT54695208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics