Provider Demographics
NPI:1831292010
Name:KASSIS, KAMAL F (MD)
Entity Type:Individual
Prefix:
First Name:KAMAL
Middle Name:F
Last Name:KASSIS
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 1:415 CHRIS GAUPP DR
Mailing Address - Street 2:CHRIS GAUPP PROFESSIONAL BLDG SUITE E
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4440
Mailing Address - Country:US
Mailing Address - Phone:609-652-5577
Mailing Address - Fax:609-652-1977
Practice Address - Street 1:415 CHRIS GAUPP DR
Practice Address - Street 2:CHRIS GAUPP PROFESSIONAL BLDG SUITE E
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4440
Practice Address - Country:US
Practice Address - Phone:609-652-5577
Practice Address - Fax:609-652-1977
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03404000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1755102Medicaid
NJ1755102Medicaid
NJ162806USQMedicare ID - Type Unspecified