Provider Demographics
NPI:1871592295
Name:CASSILLO, JAMES WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:CASSILLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5798 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6223
Mailing Address - Country:US
Mailing Address - Phone:516-795-6666
Mailing Address - Fax:516-795-6834
Practice Address - Street 1:5798 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6223
Practice Address - Country:US
Practice Address - Phone:516-795-6666
Practice Address - Fax:516-795-6834
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
NYX004518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX25861Medicare ID - Type Unspecified
NYT52884Medicare UPIN