Provider Demographics
NPI:1588728687
Name:MARK GASPARINI, D.P.M. P.C.
Entity type:Organization
Organization Name:MARK GASPARINI, D.P.M. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GASPARINI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-804-9038
Mailing Address - Street 1:119 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4601
Mailing Address - Country:US
Mailing Address - Phone:516-804-9038
Mailing Address - Fax:516-799-2595
Practice Address - Street 1:119 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4601
Practice Address - Country:US
Practice Address - Phone:516-804-9038
Practice Address - Fax:516-799-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006114213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02744232Medicaid
NY1013000405Medicare PIN
NYV07805Medicare UPIN
NY5716580001Medicare NSC