Basic Information
| Provider Information | |||||||||
| NPI: | 1245274323 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASELLI | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 294 E CRESCENT AVE | ||||||||
| Address2: | |||||||||
| City: | RAMSEY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074462004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018253692 | ||||||||
| FaxNumber: | 2018254650 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 ALBANY POST RD. ROUTE 9 A | ||||||||
| Address2: | VA HUDSON VALLEY HEALTH CARE SYSTEM MONTROSE CAMPUS | ||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | 9147884274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | N2599 | NY | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.