Healthcare Provider Details

I. General information

NPI: 1639032048
Provider Name (Legal Business Name): KATIE ANN MASON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 3RD AVE
LONG BRANCH NJ
07740-6214
US

IV. Provider business mailing address

255 3RD AVE
LONG BRANCH NJ
07740-6214
US

V. Phone/Fax

Practice location:
  • Phone: 732-923-7790
  • Fax:
Mailing address:
  • Phone: 732-923-7790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NR24812800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: