Healthcare Provider Details

I. General information

NPI: 1619091014
Provider Name (Legal Business Name): DR. DAVID B. KASSOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 STATE ROUTE 18 SUITE 102
EAST BRUNSWICK NJ
08816-1913
US

IV. Provider business mailing address

223 STATE ROUTE 18 SUITE 102
EAST BRUNSWICK NJ
08816-1913
US

V. Phone/Fax

Practice location:
  • Phone: 732-246-1969
  • Fax: 732-843-3705
Mailing address:
  • Phone: 732-246-1969
  • Fax: 732-843-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA03297600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: