Provider Demographics
NPI:1992826994
Name:MASSOP-FLOWERS, ALICIA (DO)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:MASSOP-FLOWERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13930 225TH ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2741
Mailing Address - Country:US
Mailing Address - Phone:716-766-7408
Mailing Address - Fax:
Practice Address - Street 1:515 WEST 207 STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034
Practice Address - Country:US
Practice Address - Phone:212-694-2000
Practice Address - Fax:212-281-4296
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1992826994Medicaid