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General NPI Number Information
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NPI Number | 1982003380
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Entity Type | Individual
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Provider Name | JOHANNA CABASSA M.D
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Gender | Female
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Dates
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Enumeration Date | 08/21/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 111 E 210TH ST # STREET1
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City | BRONX
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State | NY
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Zip | 10467-2401
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Country | US
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Telephone | 718-920-4951
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E 210TH ST OUTPATIENT DEPARTMENT OF PSYCHIATRY
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City | BRONX
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State | NY
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Zip | 10467-2401
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Country | US
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Telephone | 718-920-4951
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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 | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 276079-1
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License Number State | NY
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