Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 154187 | NY |
NPI | 1194745299 |
---|---|
Provider Name | Thomas D Masten |
First Address | East Syracuse, NY 13057-9717 |
Second Address | East Syracuse, NY 13057-9717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 21/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00920549 | (05) | NY |