Provider Demographics
NPI:1457572794
Name:MASTELLONE INC
Entity Type:Organization
Organization Name:MASTELLONE INC
Other - Org Name:JAMES A MASTELLONE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASTELLONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-287-4277
Mailing Address - Street 1:1807 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-7204
Mailing Address - Country:US
Mailing Address - Phone:772-287-4277
Mailing Address - Fax:772-286-6912
Practice Address - Street 1:1807 S KANNER HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-7204
Practice Address - Country:US
Practice Address - Phone:772-287-4277
Practice Address - Fax:772-286-6912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4788111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55008Medicare UPIN
FL70541Medicare ID - Type Unspecified