Provider Demographics
NPI:1003436783
Name:KASSEM, ALI (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:KASSEM
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 1:475 SEAVIEW UNIVERSITY, STATEN ISLAND, NEW YORK
Mailing Address - Street 2:STATEN ISLAND UNIVERSITY HOSPITAL, DEPARTMENT OF INTERN
Mailing Address - City:STATEN ISLAND, NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-226-8855
Mailing Address - Fax:
Practice Address - Street 1:475 SEAVIEW UNIVERSITY, STATEN ISLAND, NEW YORK
Practice Address - Street 2:STATEN ISLAND UNIVERSITY HOSPITAL, DEPARTMENT OF INTERN
Practice Address - City:STATEN ISLAND, NYC
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-226-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2022-02-09
Deactivation Date:2022-01-10
Deactivation Code:
Reactivation Date:2022-02-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program