Provider Demographics
NPI:1881737088
Name:MASCARENHAS, PATRICK (DDS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:MASCARENHAS
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LENOX RD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3704
Mailing Address - Country:US
Mailing Address - Phone:917-533-3673
Mailing Address - Fax:
Practice Address - Street 1:79 HUDSON ST STE 2
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5638
Practice Address - Country:US
Practice Address - Phone:917-533-3673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04896811223G0001X
NY0489681223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02691725Medicaid
NY02099310Medicaid
NY02691596Medicaid
NY11-3574003OtherDELANCEY TIN #
NY02099310Medicaid