Provider Demographics
NPI:1225356512
Name:RIDGEWOOD ENT & DERMATOLOGY
Entity Type:Organization
Organization Name:RIDGEWOOD ENT & DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAMTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:201-857-2370
Mailing Address - Street 1:81 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3234
Mailing Address - Country:US
Mailing Address - Phone:201-857-2370
Mailing Address - Fax:201-857-2371
Practice Address - Street 1:81 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3234
Practice Address - Country:US
Practice Address - Phone:201-857-2370
Practice Address - Fax:201-857-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207N00000X
207Q00000X, 207V00000X, 207YX0905X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty