Healthcare Provider Details

I. General information

NPI: 1063437200
Provider Name (Legal Business Name): BETH M MASSEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 HEMPSTEAD TPKE SUITE 203
LEVITTOWN NY
11756-1404
US

IV. Provider business mailing address

126 E PARK AVE
LONG BEACH NY
11561-3510
US

V. Phone/Fax

Practice location:
  • Phone: 516-731-0303
  • Fax: 516-731-6302
Mailing address:
  • Phone: 516-731-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number194285
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: