Provider Demographics
NPI:1972587186
Name:CASELNOVA, RALPH CARMINE (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:CARMINE
Last Name:CASELNOVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:250 PETTIT AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710
Mailing Address - Country:US
Mailing Address - Phone:516-409-0106
Mailing Address - Fax:516-409-0108
Practice Address - Street 1:250 PETTIT AVE
Practice Address - Street 2:STE 4
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710
Practice Address - Country:US
Practice Address - Phone:516-409-0106
Practice Address - Fax:516-409-0108
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY108144207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P1535330OtherOXFORD
390006774OtherRAILROAD MEDICARE
AE45759OtherMDNY HEALTHCARE
NY00365595Medicaid
4C1076OtherHEALTHNET
000000053679OtherGHI HMO
45006HOtherHEALTHCARE PARTNERS
108144OtherHIP
4210OtherMAGNACARE
04798GOtherGHI MEDICARE
0038690OtherGHI
52250OtherVYTRA
69117OtherBLUE SHIELD
AE45759OtherMDNY HEALTHCARE
4210OtherMAGNACARE