Provider Demographics
NPI:1831297902
Name:KASS, JEFFREY C (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:KASS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 YELLOWSTONE BLVD
Mailing Address - Street 2:# A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3268
Mailing Address - Country:US
Mailing Address - Phone:718-575-3737
Mailing Address - Fax:
Practice Address - Street 1:6812 YELLOWSTONE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3268
Practice Address - Country:US
Practice Address - Phone:718-575-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005215-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01727504Medicaid
NY4380130001Medicare NSC
NY6514UGMedicare PIN
NY02399Medicare PIN
NY01727504Medicaid