Individual provider Active NPI

Islam Kassab, PA-C

  • Surgical Physician Assistant
  • Paterson, NJ
National Provider Identifier
1831593961
Registry record updated Sep 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
25MP00354100 Issued in NJ
Practice address
703 Main Street
Paterson, NJ 07503
Phone
(973) 754-2486
Fax
(973) 754-2975
NPI assigned
Oct 17, 2014
Last updated
Sep 4, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 25MP00354100 NJ Primary

Addresses

Primary practice location

703 Main Street
Paterson, NJ 07503

Mailing address

128 Leonard St
Jersey City, NJ 07307-3102
Phone (201) 780-9487

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150130002019 NY Practitioner - Physician Assistant 1456675024 Reassigns benefits to 1 organization
I20190220000040 NJ Practitioner - Physician Assistant 1456675024 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys General Medical Group PCGroup PAC ID 5496112476, 73 clinicians
St Josephs Medical Group PCGroup PAC ID 8628470325, 217 clinicians

Practice addresses (Care Compare)

350 Boulevard
Passaic, NJ 07055-2840
Phone (973) 365-4300

703 Main St
Paterson, NJ 07503-2621

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
018168NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Prime Healthcare Services - St. Mary's Passaic, LLC CurrentSince Jul 1, 2024 Accepting new patients

Locations

111 Central Ave
Newark, NJ 07102
Phone (973) 877-5060

350 Boulevard
Passaic, NJ 07055
Phone (973) 365-4300

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536019200000",
    "number": "1831593961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 LEONARD ST",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073073102",
            "telephone_number": "201-780-9487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 MAIN STREET",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "07503",
            "telephone_number": "973-754-2486",
            "fax_number": "973-754-2975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASSAB",
        "first_name": "ISLAM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-10-17",
        "last_updated": "2018-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00354100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paterson, NJ

Sources for this page

Verify at the official NPI Registry.