Provider Demographics
NPI:1235254665
Name:MASINI, SAMUEL J (ND LAC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:J
Last Name:MASINI
Suffix:
Gender:M
Credentials:ND LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E PUTNAM AVE 3070
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5424
Mailing Address - Country:US
Mailing Address - Phone:203-536-9835
Mailing Address - Fax:
Practice Address - Street 1:15 E PUTNAM AVE 3070
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5424
Practice Address - Country:US
Practice Address - Phone:203-536-9835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT083175F00000X
NY04791171100000X
CT0139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered175F00000XOther Service ProvidersNaturopath
Not Answered171100000XOther Service ProvidersAcupuncturist