Provider Demographics
NPI:1912140948
Name:KASSOVER, MINDY JOAN (MS,PT,PCS)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:JOAN
Last Name:KASSOVER
Suffix:
Gender:F
Credentials:MS,PT,PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 S END AVE
Mailing Address - Street 2:3J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1026
Mailing Address - Country:US
Mailing Address - Phone:917-584-5103
Mailing Address - Fax:
Practice Address - Street 1:395 S END AVE
Practice Address - Street 2:3J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1026
Practice Address - Country:US
Practice Address - Phone:917-584-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007882-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics