=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285767988
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEWIS KASS, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 S BEDFORD RD STE 111
-----------------------------------------------------
City | MOUNT KISCO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10549-3452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-274-6700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 S BEDFORD RD STE 111
-----------------------------------------------------
City | MOUNT KISCO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10549-3452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-274-6700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING AGENT
-----------------------------------------------------
Name | DENISE R ROWE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-274-6700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0214X
-----------------------------------------------------
Taxonomy Name | Pediatric Pulmonology Physician
-----------------------------------------------------
License Number | 191964
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------