Provider Demographics
NPI:1689802647
Name:KASSIM, ANDREA TINUOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:TINUOLA
Last Name:KASSIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 MOUNT PLEASANT AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2744
Mailing Address - Country:US
Mailing Address - Phone:973-571-2121
Mailing Address - Fax:
Practice Address - Street 1:347 MOUNT PLEASANT AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2744
Practice Address - Country:US
Practice Address - Phone:973-571-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125057163207N00000X
NY266015207N00000X
NJ25MA09182700207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY257102VFQMedicare PIN