Provider Demographics
NPI:1265994693
Name:MASLENNIKOV, MASHA (WHNP-BC)
Entity type:Individual
Prefix:
First Name:MASHA
Middle Name:
Last Name:MASLENNIKOV
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:FL 3
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-777-3569
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:257 LAFAYETTE AVE STE 380
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4829
Practice Address - Country:US
Practice Address - Phone:845-777-3569
Practice Address - Fax:845-533-7464
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019111363LW0102X
NY421474363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health