Provider Demographics
NPI:1659501088
Name:MICHAEL J KASSOUF, MD.,PC
Entity Type:Organization
Organization Name:MICHAEL J KASSOUF, MD.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KASSOUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-238-0131
Mailing Address - Street 1:346 76TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3106
Mailing Address - Country:US
Mailing Address - Phone:718-238-0131
Mailing Address - Fax:
Practice Address - Street 1:346 76TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3106
Practice Address - Country:US
Practice Address - Phone:718-238-0131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00460839Medicaid
NY00460839Medicaid