Kristin Leigh Casasanta, M.D.
Individual provider Active NPI Pediatrics Physician · Mamaroneck, NY
NPI 1942469622 · NPPES record last updated Nov 18, 2015
Key facts
- NPI
- 1942469622
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 281956 (NY)
- Practice address
- 620 E Boston Post Rd
Mamaroneck, NY 10543-3741 - Phone
- (914) 777-5437
- Fax
- (914) 630-0907
- NPI assigned
- Jun 6, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CT, NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170303000557 | CT | Practitioner - Pediatric Medicine | 5092983023 | Reassigns benefits to 2 organizations |
| I20180822002053 | NY | Practitioner - Pediatric Medicine | 5092983023 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 281956 | NY | MD | Licensed Practical Nurse |
| 54695 | CT | MD | Pediatrics Physician |
| D71927 | MD | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Medical Group, PLLC | Pediatrics | Current |
Accepting new patients |
| Northeast Medical Group, Inc. | Pediatrics | Current |
Accepting new patients |
| Greenwich Hospital | Current |
Accepting new patients | |
| Greenwich Hospital | Current |
Accepting new patients | |
| Northeast Medical Group Inc | Current |
Accepting new patients | |
| Medlantic Healthcare Group | Past | Accepting new patients |
Locations
5 Perryridge Rd
Greenwich, CT 06830
Phone (203) 661-5330
789 Howard Ave
North Haven, CT 06519
Phone (203) 688-2471
95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388
26 Rye Ridge Plz
Rye Brook, NY 10573
Phone (914) 251-1100
18 Rye Ridge Plz
Rye Brook, NY 10573
Phone (914) 253-9252
Interoperability endpoints
- kcasasanta349972@direct.ynhh.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D71927 | MD | |
| Pediatrics Physician | 208000000X | 281956 | NY | Yes |
| Pediatrics Physician | 208000000X | 54695 | CT |
Addresses
Primary practice location
620 E Boston Post Rd
Mamaroneck, NY 10543-3741
Mailing address
620 E Boston Post Rd
Mamaroneck, NY 10543-3741
Phone (914) 777-5437
Other providers in Mamaroneck, NY
- Caren Sacks Ma, Atr-BC, Lcat, PLLC
- Jacquelyn Laura Carlesimo
- Sarah Ann Carney
- Edward F Carpenter
- Nichole Cartagena
- Joel Casaverde
- Kathleen M Casey-Paulsen
- Nilton Castro
- Yancy Jose Castro
- Cecilia Alvarez
All providers in Mamaroneck, NY · Pediatrics Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.