Provider Demographics
NPI:1457311383
Name:MASTROBATTISTA, SCOTT PATRICK (MSED, ATC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:PATRICK
Last Name:MASTROBATTISTA
Suffix:
Gender:M
Credentials:MSED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6432 WHITE OAK WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9573
Mailing Address - Country:US
Mailing Address - Phone:716-627-5754
Mailing Address - Fax:
Practice Address - Street 1:NIAGARA UNIVERSITY
Practice Address - Street 2:
Practice Address - City:NIAGARA UNIVERSITY
Practice Address - State:NY
Practice Address - Zip Code:14109
Practice Address - Country:US
Practice Address - Phone:716-286-8642
Practice Address - Fax:716-286-8656
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000243-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer