Provider Demographics
NPI:1952516460
Name:PASQUA-MASBACK, VALERIANA (CNM)
Entity Type:Individual
Prefix:
First Name:VALERIANA
Middle Name:
Last Name:PASQUA-MASBACK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6803
Mailing Address - Country:US
Mailing Address - Phone:845-426-4686
Mailing Address - Fax:
Practice Address - Street 1:75 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-6803
Practice Address - Country:US
Practice Address - Phone:845-426-4686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF 000410176B00000X
NJ25ME00032100176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01661283Medicaid