Healthcare Provider Details

I. General information

NPI: 1023304169
Provider Name (Legal Business Name): OLIVER MASABA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MIRACLE MILE DR
ROCHESTER NY
14623-5851
US

IV. Provider business mailing address

4901 LAC DE VILLE BLVD
ROCHESTER NY
14618-5647
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5321
  • Fax:
Mailing address:
  • Phone: 585-275-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number278585
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: