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General NPI Number Information
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NPI Number | 1831593961
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Entity Type | Individual
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Provider Name | ISLAM KASSAB PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 703 MAIN STREET
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City | PATERSON
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State | NJ
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Zip | 07503
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Country | US
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Telephone | 973-754-2486
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Fax | 973-754-2975
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Provider Business Mailing Address
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Address Line | 128 LEONARD ST
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City | JERSEY CITY
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State | NJ
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Zip | 07307-3102
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Country | US
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Telephone | 201-780-9487
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00354100
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License Number State | NJ
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