Provider Demographics
NPI:1932145687
Name:MASCARELLI, ROBERT J (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:MASCARELLI
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:998C OLD COUNTRY RD STE 132
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4917
Mailing Address - Country:US
Mailing Address - Phone:573-240-6942
Mailing Address - Fax:516-827-4517
Practice Address - Street 1:100 MERRICK RD
Practice Address - Street 2:SUITE 128W
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4800
Practice Address - Country:US
Practice Address - Phone:516-255-9031
Practice Address - Fax:616-255-6010
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY008855-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG71694Medicare UPIN
NYW01161Medicare ID - Type UnspecifiedNEUROLOGICAL SURGERY P.C.
NYA15287Medicare UPIN
NYI48219Medicare UPIN
NYC09359Medicare UPIN
NYG69563Medicare UPIN