Provider Demographics
NPI:1699850388
Name:MASUR, DAVID M (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:MASUR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:50 STONEBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1613
Mailing Address - Country:US
Mailing Address - Phone:718-944-1940
Mailing Address - Fax:718-920-8341
Practice Address - Street 1:MMC - DEPT. OF NEUROLOGY
Practice Address - Street 2:111 EAST 210TH STREET, NW BSMT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-944-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009384103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist