Healthcare Provider Details

I. General information

NPI: 1215015359
Provider Name (Legal Business Name): JOSHUA MASON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S BUILDING 4, 4TH FLOOR
BRONX NY
10461-1138
US

IV. Provider business mailing address

1400 PELHAM PKWY S BUILDING 4, 4TH FLOOR
BRONX NY
10461-1138
US

V. Phone/Fax

Practice location:
  • Phone: 646-614-9201
  • Fax: 718-918-7526
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number224981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: