Provider Demographics
NPI:1003184961
Name:R J MASCITELLI MD PC
Entity Type:Organization
Organization Name:R J MASCITELLI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAKAYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-472-7777
Mailing Address - Street 1:420 E 72ND ST
Mailing Address - Street 2:STE 1J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4650
Mailing Address - Country:US
Mailing Address - Phone:212-472-7777
Mailing Address - Fax:212-472-2272
Practice Address - Street 1:420 E 72ND ST
Practice Address - Street 2:STE 1J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4650
Practice Address - Country:US
Practice Address - Phone:212-472-7777
Practice Address - Fax:212-472-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB13192Medicare UPIN