Provider Demographics
NPI:1447618723
Name:MASTRACCHIO, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:MASTRACCHIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:BAUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:266 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-4429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:266 WHITE PLAINS RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-4429
Practice Address - Country:US
Practice Address - Phone:914-337-3026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY174400000XOtherTEACHER