Provider Demographics
NPI:1649361114
Name:MASCIOLI, GEORGE E (OD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:E
Last Name:MASCIOLI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ELAINE DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5709
Mailing Address - Country:US
Mailing Address - Phone:718-297-2953
Mailing Address - Fax:718-297-5629
Practice Address - Street 1:16930 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5218
Practice Address - Country:US
Practice Address - Phone:718-297-2953
Practice Address - Fax:718-297-5629
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3948-T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00497645Medicaid
NY0492882OtherAETNA
NYP1865484OtherOXFORD
NY00497645Medicaid
NYT49046Medicare UPIN