Provider Demographics
NPI:1407844590
Name:MASABA, EDIT KALMAR (MD)
Entity Type:Individual
Prefix:
First Name:EDIT
Middle Name:KALMAR
Last Name:MASABA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4573 STATE ROUTE 40
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:NY
Mailing Address - Zip Code:12809
Mailing Address - Country:US
Mailing Address - Phone:518-638-8274
Mailing Address - Fax:
Practice Address - Street 1:4573 STATE ROUTE 40
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:NY
Practice Address - Zip Code:12809
Practice Address - Country:US
Practice Address - Phone:518-638-8274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01830895Medicaid
NYP00010322OtherRR MEDICARE
NYDD5291Medicare ID - Type Unspecified
G36431Medicare UPIN