Provider Demographics
NPI:1609215706
Name:KAZL, CASSANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:KAZL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6739
Mailing Address - Country:US
Mailing Address - Phone:646-558-0800
Mailing Address - Fax:646-754-9800
Practice Address - Street 1:222 E 41ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6739
Practice Address - Country:US
Practice Address - Phone:646-558-0800
Practice Address - Fax:646-754-9800
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2957972084N0402X
MA264082208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA264082OtherMASSACHUSETTES MEDICAL LICENSE
PAMT205265OtherPENNSYLVANIA STATE BOARD OF MEDICINE, MEDICAL LICENSE