Healthcare Provider Details

I. General information

NPI: 1699761015
Provider Name (Legal Business Name): HARVEY G MASOR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 CHANCELLOR AVE
IRVINGTON NJ
07111-2953
US

IV. Provider business mailing address

739 CHANCELLOR AVE
IRVINGTON NJ
07111-2953
US

V. Phone/Fax

Practice location:
  • Phone: 973-371-5959
  • Fax: 973-371-0171
Mailing address:
  • Phone: 973-371-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA02102900
License Number StateNJ

VIII. Authorized Official

Name: HARVEY G MASOR
Title or Position: MD
Credential: MD
Phone: 973-371-5959