Jack Kassab, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

049782 Issued in NY

Practice address

1176 Liberty Ave
Brooklyn, NY 11208-3309

Phone

(718) 827-6001

NPI assigned

Oct 31, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760473888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1176 LIBERTY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112083309",
            "telephone_number": "718-827-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1176 LIBERTY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112083309",
            "telephone_number": "718-827-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASSAB",
        "first_name": "JACK",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "049782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Ann Kasper, PSYD
• Archil Kasradze
• Lana Kass-Gergi, MD
• Nabil Kass-Gergi, R.PH.
• Elia Kassab, M.D.
• Maggie Kassab, PHARM.D.
• Husam Kassem, PHARMD
• Christian Samir Kassicieh, DO
• Eli David Kassin, OD
• Esther Liliane Kassin, DPT

• Dentist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.