Provider Demographics
NPI:1649457656
Name:GAETA, KASEY LYNN (ESQ)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:LYNN
Last Name:GAETA
Suffix:
Gender:F
Credentials:ESQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1654 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1529
Mailing Address - Country:US
Mailing Address - Phone:718-761-2900
Mailing Address - Fax:718-761-0146
Practice Address - Street 1:1654 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1529
Practice Address - Country:US
Practice Address - Phone:718-761-2900
Practice Address - Fax:718-761-0146
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046817-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist