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General NPI Number Information
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NPI Number | 1063577104
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Entity Type | Organization
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Legal Business Name | KAMAL F KASSIS MD PC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 415 S CHRIS GAUPP DRIVE CHRIS GAUPP PROFESSIONAL BLDG
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City | GALLOWAY
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State | NJ
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Zip | 08205-4440
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Country | US
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Telephone | 609-652-5577
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Fax | 609-652-1977
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Provider Business Mailing Address
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Address Line | 415 S CHRIS GAUPP DRIVE CHRIS GAUPP PROFESSIONAL BLDG
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City | GALLOWAY
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State | NJ
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Zip | 08205-4440
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Country | US
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Telephone | 609-652-5577
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Fax | 609-652-1977
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. KAMAL F KASSIS
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Credential | MD
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Telephone | 609-652-5577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA07598000
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License Number State | NJ
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