Provider Demographics
NPI:1396790820
Name:MAST, HAROLD L (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:L
Last Name:MAST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-5230
Mailing Address - Country:US
Mailing Address - Phone:732-383-4173
Mailing Address - Fax:732-741-1895
Practice Address - Street 1:741 NORTHFIELD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1174
Practice Address - Country:US
Practice Address - Phone:973-243-9729
Practice Address - Fax:973-243-9672
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA059350002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6034501Medicaid
F19467Medicare UPIN
NJ300045496Medicare PIN
NJ518374A2VMedicare PIN
NJ518374CQHMedicare PIN