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NPI Code Detail

MEDICARE: ELLIS MASTERMAN

MEDICARE:   ELLIS  MASTERMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1275201469
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLIS MASTERMAN
Provider Business Mailing Address
First Line : 1311 MAMARONECK AVE STE 140
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-5224
Country : US
Telephone Number : 914-294-4050
Fax Number :
Provider Business Practice Location Address
First Line : 490 DRIGGS AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11211-2019
Country : US
Telephone Number : 718-230-1180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2021
Last Update Date : 09/01/2021

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Directions to “ ELLIS MASTERMAN ” Practice Location

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