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: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 ROUTE 25A STE 10
MILLER PLACE NY
11764-2647
US

IV. Provider business mailing address

595 ROUTE 25A STE 10
MILLER PLACE NY
11764-2647
US

V. Phone/Fax

Practice location:
  • Phone: 631-621-2256
  • Fax: 844-749-4137
Mailing address:
  • Phone: 631-621-2256
  • Fax: 844-749-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number301464-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: