Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 128671 | NY |
NPI | 1114968708 |
---|---|
Provider Name | Dr. Peter A Masella |
First Address | Bronx, NY 10467-8044 |
Second Address | Bronx, NY 10458-6700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A97625 | (02) |