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General NPI Number Information
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NPI Number | 1417513367
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Entity Type | Individual
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Provider Name | BRIAN JOSEPH KASSA
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Gender | Male
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 1044 BELMONT AVE # MEDED2S
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City | YOUNGSTOWN
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State | OH
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Zip | 44504-1006
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Country | US
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Telephone | 330-480-2994
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 BOARDMAN CANFIELD RD APT 74C
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City | BOARDMAN
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State | OH
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Zip | 44512-8054
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Country | US
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Telephone | 248-860-8662
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 58.031112
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 58.031112
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License Number State | OH
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