Provider Demographics
NPI:1184668196
Name:LASSEN, BRETT (PA)
Entity type:Individual
Prefix:MR
First Name:BRETT
Middle Name:
Last Name:LASSEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-7616
Mailing Address - Country:US
Mailing Address - Phone:914-831-4160
Mailing Address - Fax:914-831-4161
Practice Address - Street 1:73 MARKET ST
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-7616
Practice Address - Country:US
Practice Address - Phone:914-831-4160
Practice Address - Fax:914-831-4161
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007770363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1047917OtherNCCPA CERTIFICATE NUMBER
1047917OtherNCCPA CERTIFICATE NUMBER
NYDH0034Medicare PIN
NY2D159NW221Medicare PIN