Provider Demographics
NPI:1679819981
Name:MASSASATI, LAMAH (MD)
Entity Type:Individual
Prefix:
First Name:LAMAH
Middle Name:
Last Name:MASSASATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3403
Mailing Address - Country:US
Mailing Address - Phone:914-787-6069
Mailing Address - Fax:914-787-2143
Practice Address - Street 1:55 PALMER AVE
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3403
Practice Address - Country:US
Practice Address - Phone:914-787-6069
Practice Address - Fax:914-787-2143
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275907207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009572000Medicaid
FL009572000Medicaid