Provider Demographics
NPI:1659540706
Name:JEFFREY KASS DPM PC
Entity Type:Organization
Organization Name:JEFFREY KASS DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KASS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-575-3737
Mailing Address - Street 1:6812 YELLOWSTONE BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3268
Mailing Address - Country:US
Mailing Address - Phone:718-575-3737
Mailing Address - Fax:
Practice Address - Street 1:6812 YELLOWSTONE BLVD
Practice Address - Street 2:STE A
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3268
Practice Address - Country:US
Practice Address - Phone:718-575-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005215213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4380130001Medicare NSC