Healthcare Provider Details

I. General information

NPI: 1326210568
Provider Name (Legal Business Name): HOUSLANGER & KASSNOVE, PODIATRISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440-3 WAVERLY AVE STE 3
PATCHOGUE NY
11772
US

IV. Provider business mailing address

440-3 WAVERLY AVE STE 3
PATCHOGUE NY
11772
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-3838
  • Fax: 631-654-3832
Mailing address:
  • Phone: 631-654-3838
  • Fax: 631-654-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005591
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MATTHEW KASSNOVE
Title or Position: PARTNER
Credential: DPM
Phone: 631-654-3838