1548256720 NPI number — DR. JOSEPH MASELLI MD

Table of content: DR. JOSEPH MASELLI MD (NPI 1548256720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548256720 NPI number — DR. JOSEPH MASELLI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASELLI
Provider First Name:
JOSEPH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548256720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 ROUTE 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10956-3041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-634-8400
Provider Business Mailing Address Fax Number:
845-634-0979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 ROUTE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10956-3041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-634-8400
Provider Business Practice Location Address Fax Number:
845-634-0979
Provider Enumeration Date:
09/23/2005

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: 207V00000X , with the licence number:  135067 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002942 . This is a "CONNECTICARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0122670 . This is a "AETNA HMO#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 135067 . This is a "HIP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: RS028 . This is a "OXFORD ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0052769 . This is a "GHI PPO ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0D4712 . This is a "HEALTHNET ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 160015222 . This is a "RAILROAD MEDICARE ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 51A251 . This is a "EMPIRE BC/BS NEW CITY #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 51A253 . This is a "EMPIRE BC/BS STONY PT, #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4125809 . This is a "MVP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1601397 . This is a "CHUBB/HEALTHSOURCE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4096886 . This is a "AETNA PPO ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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