MEDICARE: MS. LALA KASSIM MS ED.

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	174H00000X	Health Educator
2	174400000X	Specialist		NY

General Provider Information

NPI Number	:	1669758272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LALA KASSIM MS ED.

Provider Business Mailing Address
First Line	:	173 FOSTER RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	173 FOSTER RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3041
Country	:	US
Telephone Number	:	718-948-4466
Fax Number	:

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

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	06/13/2012

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