Provider Demographics
NPI:1720076060
Name:CASO, GINA S (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:S
Last Name:CASO
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 1:155 W MERRICK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3743
Mailing Address - Country:US
Mailing Address - Phone:516-379-3139
Mailing Address - Fax:516-379-5790
Practice Address - Street 1:155 W MERRICK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3743
Practice Address - Country:US
Practice Address - Phone:516-379-3139
Practice Address - Fax:516-379-5790
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01880120Medicaid
NYI64466Medicare UPIN