Provider Demographics
NPI:1831823764
Name:CASIMIRO, GERARD RYAN (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:RYAN
Last Name:CASIMIRO
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W 53RD ST APT 514
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5634
Mailing Address - Country:US
Mailing Address - Phone:630-815-2289
Mailing Address - Fax:
Practice Address - Street 1:410 W 53RD ST APT 514
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5634
Practice Address - Country:US
Practice Address - Phone:630-815-2289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021618363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care