Provider Demographics
NPI:1154433753
Name:FANNY B KASHER MD LLC
Entity type:Organization
Organization Name:FANNY B KASHER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FANNY
Authorized Official - Middle Name:BELLA
Authorized Official - Last Name:KASHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:728-273-5974
Mailing Address - Street 1:11 RALPH PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4419
Mailing Address - Country:US
Mailing Address - Phone:718-273-5974
Mailing Address - Fax:718-447-5297
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:SUITE 102
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4419
Practice Address - Country:US
Practice Address - Phone:718-273-5974
Practice Address - Fax:718-447-5297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142529208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB14270Medicare UPIN
NY40D931Medicare ID - Type Unspecified