Provider Demographics
NPI:1598210031
Name:MASOOD, HASAN (DPT)
Entity Type:Individual
Prefix:
First Name:HASAN
Middle Name:
Last Name:MASOOD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MAMARONECK AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1316
Mailing Address - Country:US
Mailing Address - Phone:914-222-0115
Mailing Address - Fax:702-852-0631
Practice Address - Street 1:222 MAMARONECK AVE STE 310
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1316
Practice Address - Country:US
Practice Address - Phone:914-222-0115
Practice Address - Fax:702-852-0631
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV2051213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program