Provider Demographics
NPI:1669519583
Name:MASON-FOGAH, RHONA (MSPT)
Entity type:Individual
Prefix:
First Name:RHONA
Middle Name:
Last Name:MASON-FOGAH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14724 225TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-4101
Mailing Address - Country:US
Mailing Address - Phone:718-712-1249
Mailing Address - Fax:
Practice Address - Street 1:300 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1450
Practice Address - Country:US
Practice Address - Phone:516-505-2200
Practice Address - Fax:516-505-5416
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist