Basic Information
| Provider Information | |||||||||
| NPI: | 1356381636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASSIR | ||||||||
| FirstName: | JORGE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020A E BOAL AVE | ||||||||
| Address2: | |||||||||
| City: | BOALSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168271509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142378627 | ||||||||
| FaxNumber: | 8142380083 | ||||||||
| Practice Location | |||||||||
| Address1: | JIMMIE LEEDS RD | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096523417 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 08/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 25MA03502000 | NJ | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 7209255003 | 01 | NJ | CIGNA HMO | OTHER | 0427101 | 05 | NJ | MEDICAID | 0372094000 | 01 | PA | IBC/KHPE | OTHER | 1169567 | 01 | NJ | HORIZON MERCY | OTHER | 0372094000 | 01 | NJ | AMERIHEALTH | OTHER | P3060240 | 01 | NJ | OXFORD | OTHER | 3080955 | 01 | NJ | USHC | OTHER |