MEDICARE: ILENE NAN KASSMAN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F354172-01	NY

General Provider Information

NPI Number	:	1578304028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILENE NAN KASSMAN FNP

Provider Business Mailing Address
First Line	:	36 CARLTON DR
Second Line	:
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-4756
Country	:	US
Telephone Number	:	914-263-6492
Fax Number	:

Provider Business Practice Location Address
First Line	:	2960 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1904
Country	:	US
Telephone Number	:	718-295-6815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	06/06/2024

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