Provider Demographics
NPI:1891803953
Name:MOUNT PLEASANT MEDICAL GROUP, LLP
Entity Type:Organization
Organization Name:MOUNT PLEASANT MEDICAL GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MASBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-769-0268
Mailing Address - Street 1:401 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1325
Mailing Address - Country:US
Mailing Address - Phone:914-769-0268
Mailing Address - Fax:914-769-6303
Practice Address - Street 1:401 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1325
Practice Address - Country:US
Practice Address - Phone:914-769-0268
Practice Address - Fax:914-769-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMO0W009910Medicare ID - Type UnspecifiedMEDICARE GP #