MEDICARE: ALAN MASIA M.D.

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
1	2080A0000X	Pediatric Adolescent Medicine Physician	146616	NY

General Provider Information

NPI Number	:	1578536264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN MASIA M.D.

Provider Business Mailing Address
First Line	:	101 2ND ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3324
Country	:	US
Telephone Number	:	732-363-6655
Fax Number	:	732-901-0277

Provider Business Practice Location Address
First Line	:	101 2ND ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3324
Country	:	US
Telephone Number	:	732-363-6655
Fax Number	:	732-901-0277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2006
Last Update Date	:	12/02/2011

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