Provider Demographics
NPI:1700631850
Name:MASON, DANIEL PAYNE
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PAYNE
Last Name:MASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 W 232ND ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3207
Mailing Address - Country:US
Mailing Address - Phone:718-884-2992
Mailing Address - Fax:
Practice Address - Street 1:640 W 232ND ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3207
Practice Address - Country:US
Practice Address - Phone:718-884-2992
Practice Address - Fax:718-884-2901
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5470175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist