Healthcare Provider Details

I. General information

NPI: 1427155605
Provider Name (Legal Business Name): M J MELTZER & D G KASSAN MD LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 GLEN COVE RD STE 306
ROSLYN HEIGHTS NY
11577-1726
US

IV. Provider business mailing address

70 GLEN COVE RD STE 306
ROSLYN HEIGHTS NY
11577-1726
US

V. Phone/Fax

Practice location:
  • Phone: 516-621-7720
  • Fax: 516-625-4521
Mailing address:
  • Phone: 516-621-7720
  • Fax: 516-625-4521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL GILEAD KASSAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 516-621-7720