Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 278585 | NY |
NPI | 1023304169 |
---|---|
Provider Name | Dr. Oliver Masaba |
First Address | Rego Park, NY 11374-1136 |
Second Address | Rego Park, NY 11374-1136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 16/07/2015 |