Provider Demographics
NPI:1033118534
Name:CAISLEY, IAN JD (MD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:JD
Last Name:CAISLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-1310
Mailing Address - Country:US
Mailing Address - Phone:716-326-7200
Mailing Address - Fax:716-326-6644
Practice Address - Street 1:111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-1310
Practice Address - Country:US
Practice Address - Phone:716-326-7200
Practice Address - Fax:716-326-6644
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211732208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01892584Medicaid
NY01892584Medicaid
NYC67989Medicare UPIN