Provider Demographics
NPI:1215254727
Name:CASEY, ERIN M (PA-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:CASEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 PARK ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1506
Mailing Address - Country:US
Mailing Address - Phone:315-229-5392
Mailing Address - Fax:315-229-5514
Practice Address - Street 1:76 PARK ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1506
Practice Address - Country:US
Practice Address - Phone:315-229-5392
Practice Address - Fax:315-229-5514
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013984363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01995615Medicaid
NY01995615Medicaid