Provider Demographics
NPI:1154315554
Name:MAS, EDDIE EUGENIO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:EUGENIO
Last Name:MAS
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 1:172 SLADE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2643
Mailing Address - Country:US
Mailing Address - Phone:716-823-3300
Mailing Address - Fax:716-823-0757
Practice Address - Street 1:172 SLADE AVE
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2643
Practice Address - Country:US
Practice Address - Phone:716-823-3300
Practice Address - Fax:716-823-0757
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-09-22
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
NY187156174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010112303OtherUNIVERA HEALTHCARE
NY01331722Medicaid
NY0001011234OtherUNIVERA
NY000511359010OtherB/C&B/S COMM. BLUE
NY1010553OtherFIDELIS
NY000511359011OtherBLUE CROSS
NY0708146OtherINDEPENDENT HEALTH
RB5383OtherMEDICARE
NY060413000064OtherFIDELIS
NY01331722Medicaid
NY000511359010OtherB/C&B/S COMM. BLUE