Provider Demographics
NPI:1700859899
Name:MASEDA, MIGUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:MASEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-5116
Mailing Address - Country:US
Mailing Address - Phone:732-681-2550
Mailing Address - Fax:
Practice Address - Street 1:709 7TH AVE
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2736
Practice Address - Country:US
Practice Address - Phone:732-681-2550
Practice Address - Fax:732-681-6316
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03540900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0999105Medicaid
NJ0K7969OtherHEALTHNET
NJ223360408-026OtherQUALCARE
NJP451940OtherOXFORD
NJ110172489OtherRAILROAD MEDICARE
NJ0999105Medicaid
NJ110172489OtherRAILROAD MEDICARE