Provider Demographics
NPI:1467554840
Name:KASSOVER, BARUCH (MD)
Entity Type:Individual
Prefix:DR
First Name:BARUCH
Middle Name:
Last Name:KASSOVER
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 1:1204 B 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:718-868-0320
Mailing Address - Fax:718-868-0481
Practice Address - Street 1:2001 OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11509
Practice Address - Country:US
Practice Address - Phone:516-371-0765
Practice Address - Fax:516-371-2866
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01495523Medicaid
2500300OtherGHI
P406990OtherOXFORD
2C1296OtherHEALTHNET
00074OtherGHI MEDICARE
1003605OtherAETNA
2C1296OtherHEALTHNET
72F321Medicare ID - Type Unspecified