Provider Demographics
NPI:1932452521
Name:OCASIO, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:OCASIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1499
Mailing Address - Country:US
Mailing Address - Phone:718-781-8398
Mailing Address - Fax:718-228-4462
Practice Address - Street 1:385 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1499
Practice Address - Country:US
Practice Address - Phone:718-781-8398
Practice Address - Fax:718-228-4462
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY858590174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist