Provider Demographics
NPI:1609148956
Name:JAY S.H. MASSERMAN, M.D., INC.
Entity Type:Organization
Organization Name:JAY S.H. MASSERMAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:SH
Authorized Official - Last Name:MASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-556-0536
Mailing Address - Street 1:11180 WARNER AVENUE
Mailing Address - Street 2:SUITE 455
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-556-0536
Mailing Address - Fax:714-435-9640
Practice Address - Street 1:11180 WARNER AVE.
Practice Address - Street 2:SUITE #455
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-556-0536
Practice Address - Fax:714-435-9640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45641Medicare UPIN