Provider Demographics
NPI:1235422114
Name:MASON-MACKAY, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MASON-MACKAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 BROADWAY
Mailing Address - Street 2:STE.2824
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2701
Mailing Address - Country:US
Mailing Address - Phone:212-981-1977
Mailing Address - Fax:212-643-9192
Practice Address - Street 1:61 BROADWAY
Practice Address - Street 2:STE.2824
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2701
Practice Address - Country:US
Practice Address - Phone:212-981-1977
Practice Address - Fax:212-643-9192
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033532-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist