Provider Demographics
NPI:1831361336
Name:ANTHONY G CASERTA LTD.
Entity type:Organization
Organization Name:ANTHONY G CASERTA LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CASERTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-748-1861
Mailing Address - Street 1:7133 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1608
Mailing Address - Country:US
Mailing Address - Phone:718-748-1861
Mailing Address - Fax:718-491-5527
Practice Address - Street 1:7133 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1608
Practice Address - Country:US
Practice Address - Phone:718-748-1861
Practice Address - Fax:718-491-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3390274OtherNABP
NY01040353Medicaid
NY0464350001Medicare NSC