Healthcare Provider Details

I. General information

NPI: 1386924751
Provider Name (Legal Business Name): KASSECH BROUK LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 STATE ST SUITE 140
ROCHESTER NY
14614-1353
US

IV. Provider business mailing address

9 CHARTER OAKS DRIVE
PITTSFORD NY
14534
US

V. Phone/Fax

Practice location:
  • Phone: 585-454-3550
  • Fax:
Mailing address:
  • Phone: 585-953-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number195906-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: