Healthcare Provider Details

I. General information

NPI: 1235467952
Provider Name (Legal Business Name): ALISON ROBIN MASTANDREA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 BUCK BROOK RD
ROSCOE NY
12776-5612
US

IV. Provider business mailing address

241 BUCK BROOK RD
ROSCOE NY
12776-5612
US

V. Phone/Fax

Practice location:
  • Phone: 845-482-5431
  • Fax: 845-482-9054
Mailing address:
  • Phone: 845-482-5431
  • Fax: 845-482-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number507691-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number507691-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN-578757
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: