Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 194285 | NY |
NPI | 1063437200 |
---|---|
Provider Name | Dr. Beth M Massey |
First Address | Long Beach, NY 11561-3510 |
Second Address | Levittown, NY 11756-1404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 18/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F99102 | (02) | NY |