Provider Demographics
NPI:1619091014
Name:KASSOFF, DAVID B
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:KASSOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 STATE ROUTE 18
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1913
Mailing Address - Country:US
Mailing Address - Phone:732-246-1969
Mailing Address - Fax:732-843-3705
Practice Address - Street 1:223 STATE ROUTE 18
Practice Address - Street 2:SUITE 102
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1913
Practice Address - Country:US
Practice Address - Phone:732-246-1969
Practice Address - Fax:732-843-3705
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA032976002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ442366Medicare ID - Type UnspecifiedMEDICARE ID