Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 25MA07540800 | NJ |
N | 207PP0204X | Pediatric Emergency Physician | MD042163E | PA |
NPI | 1598715690 |
---|---|
Provider Name | Dr. Zach Kassutto |
First Address | Elkins Park, PA 19027-2413 |
Second Address | Livingston, NJ 07039-1600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 23/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014294350017 | (05) | PA |
F67063 | (02) |