Healthcare Provider Details

I. General information

NPI: 1346290129
Provider Name (Legal Business Name): JAMES VINCENT MASONE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MILLER WOODS DR
MILLER PLACE NY
11764-1524
US

IV. Provider business mailing address

PO BOX 5140
MILLER PLACE NY
11764-1104
US

V. Phone/Fax

Practice location:
  • Phone: 631-476-7330
  • Fax: 631-642-9242
Mailing address:
  • Phone: 631-476-7330
  • Fax: 631-642-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX008311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: