Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 107303 | NY |
NPI | 1538129937 |
---|---|
Provider Name | Dr. Bento R Mascarenhas |
First Address | White Plains, NY 10605-2523 |
Second Address | Bronxville, NY 10708-3809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 06/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107303 | STATE LICENSE (01) | NY |
B20391 | (02) | NY |