Provider Demographics
NPI:1174876486
Name:GARY S KASTEN DO PC
Entity type:Organization
Organization Name:GARY S KASTEN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KASTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO PC
Authorized Official - Phone:631-244-2442
Mailing Address - Street 1:1223 MONTAUK HWY STE B
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1491
Mailing Address - Country:US
Mailing Address - Phone:631-244-2442
Mailing Address - Fax:631-244-2445
Practice Address - Street 1:1223 MONTAUK HWY STE B
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1491
Practice Address - Country:US
Practice Address - Phone:631-244-2442
Practice Address - Fax:631-244-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY39G741Medicare PIN