Healthcare Provider Details

I. General information

NPI: 1487762019
Provider Name (Legal Business Name): LALITHA MASSON M.D., P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 WASHINGTON ST
HOBOKEN NJ
07030-4906
US

IV. Provider business mailing address

506 WASHINGTON ST
HOBOKEN NJ
07030-4906
US

V. Phone/Fax

Practice location:
  • Phone: 201-963-8554
  • Fax: 201-222-0895
Mailing address:
  • Phone: 201-963-8554
  • Fax: 201-222-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA246833
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: