Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 157890 | NY |
Y | 2084N0402X | Child Neurologist | 157890 | NY |
NPI | 1285856054 |
---|---|
Provider Name | Dr. Joelle Mast |
First Address | North Salem, NY 10560-0426 |
Second Address | Sleepy Hollow, NY 10591-1075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 01/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A65095 | (02) | NY |