1720182363 NPI number — LAWRENCE D KASSAN

Table of content: (NPI 1720182363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720182363 NPI number — LAWRENCE D KASSAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE D KASSAN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720182363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 SNYDER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19145-2719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-668-8506
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 SNYDER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19145-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-336-4151
Provider Business Practice Location Address Fax Number:
215-336-5111
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KASSAN
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
D.P.M.
Authorized Official Telephone Number:
215-336-4151

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  SC003381L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1789594 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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