Provider Demographics
NPI:1326210568
Name:HOUSLANGER & KASSNOVE, PODIATRISTS, PLLC
Entity Type:Organization
Organization Name:HOUSLANGER & KASSNOVE, PODIATRISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSNOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-654-3838
Mailing Address - Street 1:440-3 WAVERLY AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-654-3838
Mailing Address - Fax:631-654-3832
Practice Address - Street 1:440-3 WAVERLY AVE STE 3
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-654-3838
Practice Address - Fax:631-654-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005591213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6167830002Medicare NSC