Provider Demographics
NPI:1558876508
Name:MASTOV, EFRAYM (DME)
Entity Type:Individual
Prefix:
First Name:EFRAYM
Middle Name:
Last Name:MASTOV
Suffix:
Gender:M
Credentials:DME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11611 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1744
Mailing Address - Country:US
Mailing Address - Phone:347-514-9118
Mailing Address - Fax:347-514-9119
Practice Address - Street 1:11611 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1744
Practice Address - Country:US
Practice Address - Phone:347-514-9118
Practice Address - Fax:347-514-9119
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2018-01-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies