Provider Demographics
NPI:1437271616
Name:MASEFIELD&CAVALLARO PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MASEFIELD&CAVALLARO PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-259-0900
Mailing Address - Street 1:7608 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2510
Mailing Address - Country:US
Mailing Address - Phone:718-259-0900
Mailing Address - Fax:718-232-5048
Practice Address - Street 1:69 GUYON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2018
Practice Address - Country:US
Practice Address - Phone:718-979-7013
Practice Address - Fax:718-980-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQN7711OtherEMPIRE BCBS
NYQN7711OtherEMPIRE BCBS