Individual
DR. BARUCH KASSOVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2001 OCEAN BLVD, ATLANTIC BEACH, NY 11509
(516) 371-0765
(516) 371-2866
Mailing address
1204 B 9TH ST, FAR ROCKAWAY, NY 11691
(718) 868-0320
(718) 868-0481
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
183113
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00074
GHI MEDICARE
—
05
—
01495523
—
NY
01
—
1003605
AETNA
—
01
—
2500300
GHI
—
01
—
2C1296
HEALTHNET
—
01
—
P406990
OXFORD
—
Enumeration date
09/05/2006
Last updated
05/26/2011
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