1295804870 NPI number — DR. ANDREA NEUMANN-MASCIS PHD

Table of content: DR. ANDREA NEUMANN-MASCIS PHD (NPI 1295804870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295804870 NPI number — DR. ANDREA NEUMANN-MASCIS PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEUMANN-MASCIS
Provider First Name:
ANDREA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEUMANN-MASCIS
Provider Other First Name:
ANDREAS
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1295804870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 WYVERN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSLINDALE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02131-2134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-308-3242
Provider Business Mailing Address Fax Number:
617-553-1945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3464 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA PLAIN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02130-2665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-308-3242
Provider Business Practice Location Address Fax Number:
617-553-1945
Provider Enumeration Date:
11/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  8095 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1303546 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".