Healthcare Provider Details

I. General information

NPI: 1598101180
Provider Name (Legal Business Name): VICKI KUMARI MASSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 TECHNOLOGY DR
EAST SETAUKET NY
11733-4080
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-4601
  • Fax:
Mailing address:
  • Phone: 631-741-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA141922
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number301464-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: