Provider Demographics
NPI:1386103802
Name:MARIA KASDAN NURSE PRACTITIONER OF PEDIATRICS PLLC
Entity type:Organization
Organization Name:MARIA KASDAN NURSE PRACTITIONER OF PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:KASDAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:631-838-4300
Mailing Address - Street 1:47 GLENMERE LN
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1428
Mailing Address - Country:US
Mailing Address - Phone:631-838-4300
Mailing Address - Fax:
Practice Address - Street 1:168 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2004
Practice Address - Country:US
Practice Address - Phone:631-512-9260
Practice Address - Fax:631-588-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty