Provider Demographics
NPI:1962576389
Name:KASSOFF, ROBERT S (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:KASSOFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 BELLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5603
Mailing Address - Country:US
Mailing Address - Phone:516-481-6200
Mailing Address - Fax:516-481-6200
Practice Address - Street 1:2053 BELLMORE AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5603
Practice Address - Country:US
Practice Address - Phone:516-481-6200
Practice Address - Fax:516-481-6200
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8342103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV62621OtherBLUE CROSS
NY0028154OtherGHI
NY144362OtherVALUE OPTIONS
NYV62621OtherBLUE CROSS