Healthcare Provider Details

I. General information

NPI: 1801881495
Provider Name (Legal Business Name): STUART J MASTERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 STATE RTE 20
NEW LEBANON NY
12125
US

IV. Provider business mailing address

PO BOX 417
NEW LEBANON NY
12125-0417
US

V. Phone/Fax

Practice location:
  • Phone: 518-794-7216
  • Fax: 518-794-0180
Mailing address:
  • Phone: 518-794-7216
  • Fax: 518-794-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number38710
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number38710
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number232465
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: