Basic Information
Provider Information
NPI: 1598982944
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAAMANO
FirstName: LEO
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 165 MAIN ST
Address2:  
City: OSSINING
State: NY
PostalCode: 105624702
CountryCode: US
TelephoneNumber: 9145021470
FaxNumber: 9149410993
Practice Location
Address1: 5 GRACE CHURCH ST
Address2:  
City: PORT CHESTER
State: NY
PostalCode: 105734911
CountryCode: US
TelephoneNumber: 9149378899
FaxNumber: 9149377932
Other Information
ProviderEnumerationDate: 04/19/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X011136-1NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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