Healthcare Provider Details

I. General information

NPI: 1477591048
Provider Name (Legal Business Name): RAMTIN KASSIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 HAMBURG TPKE
WAYNE NJ
07470-5069
US

IV. Provider business mailing address

1176 HAMBURG TPKE
WAYNE NJ
07470-5069
US

V. Phone/Fax

Practice location:
  • Phone: 973-692-9300
  • Fax:
Mailing address:
  • Phone: 973-692-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA06573100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: