Individual
CASEY BIFONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(212) 305-2500
Mailing address
2891 MONTGOMERY ST, WANTAGH, NY 11793-2311
(516) 770-4387
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
018042
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04381215
—
NY
Enumeration date
10/13/2014
Last updated
05/16/2023
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