Provider Demographics
NPI:1083641955
Name:MASTRIANNO, FRANK LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:LOUIS
Last Name:MASTRIANNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 OLD HOOK RD
Mailing Address - Street 2:STE #38
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630
Mailing Address - Country:US
Mailing Address - Phone:201-262-0333
Mailing Address - Fax:201-634-0976
Practice Address - Street 1:466 OLD HOOK RD
Practice Address - Street 2:STE #38
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630
Practice Address - Country:US
Practice Address - Phone:201-262-0333
Practice Address - Fax:201-634-0976
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA046872207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C60505Medicare UPIN
NJ552572Medicare ID - Type Unspecified