Provider Demographics
NPI:1356543920
Name:CASLOW, MIRIAM (MD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:CASLOW
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 1:80 OLD HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1928
Mailing Address - Country:US
Mailing Address - Phone:516-883-5733
Mailing Address - Fax:
Practice Address - Street 1:80 OLD HOUSE LN
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1928
Practice Address - Country:US
Practice Address - Phone:516-883-5733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143450174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA62783Medicare UPIN