Individual
DR. MATTHEW KASSNOVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
440 WAVERLY AVE STE 3, SUITE 3, PATCHOGUE, NY 11772-1597
(631) 654-3838
(631) 654-3832
Mailing address
28 DEEPDALE DR, COMMACK, NY 11725-5506
(631) 462-0060
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
N005591
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02354814-5
—
NY
Enumeration date
12/15/2005
Last updated
01/08/2013
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