Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N005591 | NY |
NPI | 1346226909 |
---|---|
Provider Name | Dr. Matthew Kassnove |
First Address | Commack, NY 11725-5506 |
Second Address | Patchogue, NY 11772-1597 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 08/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02354814-5 | (05) | NY |
U84540 | (02) | NY |