Healthcare Provider Details

I. General information

NPI: 1477563039
Provider Name (Legal Business Name): HOSNEARA MASUB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 09 36TH AVE
LIC NY
11106
US

IV. Provider business mailing address

9 KNOLL LN
ROSLYN HEIGHTS NY
11577-2607
US

V. Phone/Fax

Practice location:
  • Phone: 718-482-0209
  • Fax: 718-482-0296
Mailing address:
  • Phone: 917-405-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number217560
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: