Provider Demographics
NPI:1013986462
Name:SADRI, KASS (MD)
Entity Type:Individual
Prefix:
First Name:KASS
Middle Name:
Last Name:SADRI
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 1:510 E 86TH TREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:212-570-6564
Mailing Address - Fax:212-517-4348
Practice Address - Street 1:510 E 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7504
Practice Address - Country:US
Practice Address - Phone:212-570-6564
Practice Address - Fax:212-517-4348
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124769207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY354471Medicare PIN
B13668Medicare UPIN
NYA400060521Medicare PIN