Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 051503 | CT |
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MA08999800 | NJ |
NPI | 1154642486 |
---|---|
Provider Name | Dr. Melissa Mascaro |
First Address | Hazlet, NJ 07730-0258 |
Second Address | Summit, NJ 07901-3570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 08/12/2021 |