Provider Demographics
NPI:1730134875
Name:MASONE, RONALD JR (PT,DPT,CSCS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:MASONE
Suffix:JR
Gender:M
Credentials:PT,DPT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 EMILY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2015
Mailing Address - Country:US
Mailing Address - Phone:631-648-4379
Mailing Address - Fax:
Practice Address - Street 1:6268 JERICHO TPKE
Practice Address - Street 2:SUITE 3
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2810
Practice Address - Country:US
Practice Address - Phone:631-543-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist