Provider Demographics
NPI:1760526164
Name:CABASSA, JOSE C (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:C
Last Name:CABASSA
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 1:269 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6445
Mailing Address - Country:US
Mailing Address - Phone:267-304-6165
Mailing Address - Fax:
Practice Address - Street 1:205 E 111TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2901
Practice Address - Country:US
Practice Address - Phone:646-864-0213
Practice Address - Fax:646-864-0237
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2622252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology