Provider Demographics
NPI:1588179568
Name:LAWRENCE D KASSAN
Entity type:Organization
Organization Name:LAWRENCE D KASSAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:215-336-4151
Mailing Address - Street 1:3458 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1604
Mailing Address - Country:US
Mailing Address - Phone:215-333-8637
Mailing Address - Fax:215-333-9875
Practice Address - Street 1:3458 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1604
Practice Address - Country:US
Practice Address - Phone:215-333-9875
Practice Address - Fax:215-333-9875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE D KASSAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003381L261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric