Healthcare Provider Details

I. General information

NPI: 1891266888
Provider Name (Legal Business Name): MR. JONATHAN CASSAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 E BRUCETON RD
PITTSBURGH PA
15236
US

IV. Provider business mailing address

545 E BRUCETON RD
PITTSBURGH PA
15236-4593
US

V. Phone/Fax

Practice location:
  • Phone: 814-244-3788
  • Fax:
Mailing address:
  • Phone: 814-244-3788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberF03732
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: