Provider Demographics
NPI:1457882987
Name:MASLOSKY, BRANDON THEODORE (LPN)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:THEODORE
Last Name:MASLOSKY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2920
Mailing Address - Country:US
Mailing Address - Phone:631-972-8850
Mailing Address - Fax:
Practice Address - Street 1:19 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2920
Practice Address - Country:US
Practice Address - Phone:631-972-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-26
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326058164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse