Provider Demographics
NPI:1265602726
Name:LAWRENCE D KASSAN
Entity type:Organization
Organization Name:LAWRENCE D KASSAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:KASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-336-4151
Mailing Address - Street 1:46 PARTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1948
Mailing Address - Country:US
Mailing Address - Phone:215-336-4151
Mailing Address - Fax:215-336-5111
Practice Address - Street 1:2101 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2719
Practice Address - Country:US
Practice Address - Phone:215-336-4151
Practice Address - Fax:215-336-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003381L332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0699100001Medicare NSC