Provider Demographics
NPI:1588728158
Name:CASSANO, KELLY (DO)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:CASSANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3211
Mailing Address - Country:US
Mailing Address - Phone:212-247-8100
Mailing Address - Fax:212-713-1631
Practice Address - Street 1:200 W 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:212-247-8100
Practice Address - Fax:212-713-1631
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133010833Other1199
NY133010833OtherAETNA
NY133010833OtherBEECH STREET
NYCK2251OtherATLANTIS
NY133010833OtherPHCS
NY133010833OtherGREAT WEST
NY202251OtherHIP
NY1C9402OtherHEALTH NET
NY46X341OtherEMPIRE BC BS FEDERAL
NYP562461OtherOXFORD
NY4305031NOtherCIGNA
NY46X341OtherEMPIRE BC BS
NY133010833OtherMULTIPLAN
NY1949120OtherUNITED HEALTH CARE
NY133010833OtherGREAT WEST
NY1949120OtherUNITED HEALTH CARE
NYG66053Medicare UPIN