Healthcare Provider Details

I. General information

NPI: 1700859899
Provider Name (Legal Business Name): MIGUEL A MASEDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 7TH AVE
BELMAR NJ
07719-2736
US

IV. Provider business mailing address

709 7TH AVE
BELMAR NJ
07719-5116
US

V. Phone/Fax

Practice location:
  • Phone: 732-681-2550
  • Fax: 732-681-6316
Mailing address:
  • Phone: 732-681-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA03540900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: