Healthcare Provider Details

I. General information

NPI: 1568768513
Provider Name (Legal Business Name): VICTOR J MASI DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 COURT ST
BROOKLYN NY
11231-4331
US

IV. Provider business mailing address

376 COURT ST
BROOKLYN NY
11231-4331
US

V. Phone/Fax

Practice location:
  • Phone: 718-625-5449
  • Fax: 718-625-3189
Mailing address:
  • Phone: 718-625-5449
  • Fax: 718-625-3189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number198455
License Number StateNY

VIII. Authorized Official

Name: DR. VICTOR J MASI
Title or Position: OWNER
Credential: D.O.
Phone: 718-625-5449