Basic Information
| Provider Information | |||||||||
| NPI: | 1326197823 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KASSABIAN | ||||||||
| FirstName: | SIMON | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2094 ALBANY POST ROAD | ||||||||
| Address2: | VA HUDSON VALLEY HEALTH CARE SYSTEM | ||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | 9147884320 | ||||||||
| Practice Location | |||||||||
| Address1: | 2094 ALBANY POST ROAD | ||||||||
| Address2: | VA HUDSON VALLEY HEALTH CARE SYSTEM | ||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | 9147884320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 02/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 174963-1 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 174963 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.