Provider Demographics
NPI:1811124084
Name:MASON NURSE PRACTITIONER IN FAMILY MEDICINE PC
Entity type:Organization
Organization Name:MASON NURSE PRACTITIONER IN FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:716-216-4424
Mailing Address - Street 1:2131 SAWYER DR STE 6
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2979
Mailing Address - Country:US
Mailing Address - Phone:716-216-4424
Mailing Address - Fax:716-216-4426
Practice Address - Street 1:2131 SAWYER DR
Practice Address - Street 2:SUITE 6
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2979
Practice Address - Country:US
Practice Address - Phone:716-216-4424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333243208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01365920Medicaid