Provider Demographics
NPI:1902388838
Name:MASCIA, KRISTIN ANNA
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANNA
Last Name:MASCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 DAVENPORT ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-5317
Mailing Address - Country:US
Mailing Address - Phone:631-355-3024
Mailing Address - Fax:
Practice Address - Street 1:161 DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-5317
Practice Address - Country:US
Practice Address - Phone:631-355-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist