Provider Demographics
NPI:1780820308
Name:MASSO, JOHN ALFRED (NP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALFRED
Last Name:MASSO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 TEANECK RD
Mailing Address - Street 2:HOME CARE DEPARTMENT
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4245
Mailing Address - Country:US
Mailing Address - Phone:201-833-3740
Mailing Address - Fax:201-833-3164
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:HOME CARE DEPARTMENT
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:201-833-3740
Practice Address - Fax:201-833-3164
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09059000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ058511Medicare PIN
P60421Medicare UPIN