Provider Demographics
NPI:1326086216
Name:MASONI, PRIVILAGE (MD)
Entity Type:Individual
Prefix:
First Name:PRIVILAGE
Middle Name:
Last Name:MASONI
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:PO BOX 40769
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-0769
Mailing Address - Country:US
Mailing Address - Phone:718-448-7543
Mailing Address - Fax:718-448-0045
Practice Address - Street 1:1032 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3626
Practice Address - Country:US
Practice Address - Phone:718-448-7543
Practice Address - Fax:718-448-0045
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18629207PE0004X
NY246241207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY246241OtherNEW YORK STATE LICENSE NUMBER
LA1110949Medicaid
NY01284873OtherAMERIGROUP
NY03079352Medicaid
NY090702000026OtherFIDELIS
NY9999999988OtherAFFINITY