Provider Demographics
NPI:1639877046
Name:MASON, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:GREEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12183-1277
Mailing Address - Country:US
Mailing Address - Phone:518-272-0282
Mailing Address - Fax:
Practice Address - Street 1:151 GEORGE ST
Practice Address - Street 2:
Practice Address - City:GREEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:12183-1277
Practice Address - Country:US
Practice Address - Phone:518-272-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty