Provider Demographics
NPI:1871814277
Name:KASEMI, ANDRIN (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRIN
Middle Name:
Last Name:KASEMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 VICTORY BLVD.
Mailing Address - Street 2:VICTORY INTERNAL MEDICINE
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-477-6900
Mailing Address - Fax:718-477-7862
Practice Address - Street 1:2315 VICTORY BLVD.
Practice Address - Street 2:VICTORY INTERNAL MEDICINE
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-477-6900
Practice Address - Fax:718-477-7862
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03823567Medicaid
NYA400095002OtherMEDICARE