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General NPI Number Information
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NPI Number | 1225356512
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Entity Type | Organization
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Legal Business Name | RIDGEWOOD ENT & DERMATOLOGY
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 81 N MAPLE AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3234
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Country | US
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Telephone | 201-857-2370
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Fax | 201-857-2371
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Provider Business Mailing Address
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Address Line | 81 N MAPLE AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3234
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Country | US
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Telephone | 201-857-2370
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Fax | 201-857-2371
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Authorized Official
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Title or Position | PHYSICIAN
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Name | RAMTIN KASSIR
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Credential | M.D., F.A.C.S.
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Telephone | 201-857-2370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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