Provider Demographics
NPI:1609847193
Name:MASTER, VIOLET S (MD)
Entity Type:Individual
Prefix:DR
First Name:VIOLET
Middle Name:S
Last Name:MASTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 ANDERSON AVE
Mailing Address - Street 2:216
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1831
Mailing Address - Country:US
Mailing Address - Phone:201-943-7246
Mailing Address - Fax:201-943-7037
Practice Address - Street 1:596 ANDERSON AVE
Practice Address - Street 2:216
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1831
Practice Address - Country:US
Practice Address - Phone:201-943-7246
Practice Address - Fax:201-943-7037
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03181700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ445309Medicare ID - Type Unspecified
NJC54743Medicare UPIN