MEDICARE: MRS. LAURAE R MASON

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	174400000X	Specialist

General Provider Information

NPI Number	:	1699471375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURAE R MASON

Provider Business Mailing Address
First Line	:	433 LAFAYETTE AVE APT 18A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-1433
Country	:	US
Telephone Number	:	646-806-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1269 MYRTLE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3203
Country	:	US
Telephone Number	:	718-384-4724
Fax Number	:

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

Provider Enumeration Date	:	02/03/2023
Last Update Date	:	02/03/2023

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Directions to “ MRS. LAURAE R MASON ” Practice Location

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