Healthcare Provider Details

I. General information

NPI: 1326197823
Provider Name (Legal Business Name): SIMON G KASSABIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 ALBANY POST ROAD VA HUDSON VALLEY HEALTH CARE SYSTEM
MONTROSE NY
10548
US

IV. Provider business mailing address

2094 ALBANY POST ROAD VA HUDSON VALLEY HEALTH CARE SYSTEM
MONTROSE NY
10548
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax: 914-788-4320
Mailing address:
  • Phone: 914-737-4400
  • Fax: 914-788-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number174963-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number174963
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: