Provider Demographics
NPI:1063577104
Name:KAMAL F KASSIS MD PC
Entity type:Organization
Organization Name:KAMAL F KASSIS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:F
Authorized Official - Last Name:KASSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-652-5577
Mailing Address - Street 1:415 S CHRIS GAUPP DRIVE
Mailing Address - Street 2:CHRIS GAUPP PROFESSIONAL BLDG
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4440
Mailing Address - Country:US
Mailing Address - Phone:609-652-5577
Mailing Address - Fax:609-652-1977
Practice Address - Street 1:415 S CHRIS GAUPP DRIVE
Practice Address - Street 2:CHRIS GAUPP PROFESSIONAL BLDG
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4440
Practice Address - Country:US
Practice Address - Phone:609-652-5577
Practice Address - Fax:609-652-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07598000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1755102Medicaid
096116Medicare ID - Type Unspecified
C5364Medicare UPIN