Provider Demographics
NPI:1285856054
Name:MAST, JOELLE (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:JOELLE
Middle Name:
Last Name:MAST
Suffix:
Gender:F
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:NORTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10560-0426
Mailing Address - Country:US
Mailing Address - Phone:914-592-7138
Mailing Address - Fax:914-592-0712
Practice Address - Street 1:755 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1075
Practice Address - Country:US
Practice Address - Phone:914-358-0188
Practice Address - Fax:914-358-0189
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157890208000000X, 2080H0002X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA65095Medicare UPIN