Provider Demographics
NPI:1982165593
Name:KASMARCIK, PHILIP (NP)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:KASMARCIK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:PHILIP
Other - Middle Name:
Other - Last Name:NEDLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:33 LEWIS RD
Mailing Address - Street 2:2ND FL
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:119 WHIG ST
Practice Address - Street 2:
Practice Address - City:NEWARK VALLEY
Practice Address - State:NY
Practice Address - Zip Code:13811-2423
Practice Address - Country:US
Practice Address - Phone:607-642-5211
Practice Address - Fax:607-642-8908
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily