Provider Demographics
NPI:1144387630
Name:MASTROBATTISTA, JOHN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:MASTROBATTISTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:169 E 62ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7605
Mailing Address - Country:US
Mailing Address - Phone:212-688-9365
Mailing Address - Fax:612-688-9372
Practice Address - Street 1:169 E 62ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7605
Practice Address - Country:US
Practice Address - Phone:212-688-9365
Practice Address - Fax:612-688-9372
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY178843207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160940OtherELDERPLAN
0400339OtherGHS
010178843NY00OtherANTHEM HEALTH
80314OtherUNICARE
462099OtherAETNA US HEALTHCARE
09732POtherHIP
178843A26OtherHEALTHFIRST
NY01500861Medicaid
P471036OtherOXFORD
M58843OtherATLANTIS
1058199OtherUNITED HEALTHCARE
57K011OtherEMPIRE BLUE CROSS BLUE SH
010178843NY00OtherANTHEM HEALTH
57K011OtherEMPIRE BLUE CROSS BLUE SH