Healthcare Provider Details

I. General information

NPI: 1609530005
Provider Name (Legal Business Name): MINIMALLY INVASIVE FOOT & ANKLE SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 01/19/2024
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MAMARONECK AVE STE 310
WHITE PLAINS NY
10605-1316
US

IV. Provider business mailing address

275 BRANDYWINE DR
ORANGEBURG NY
10962-2602
US

V. Phone/Fax

Practice location:
  • Phone: 914-222-0115
  • Fax: 702-852-0631
Mailing address:
  • Phone: 845-536-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HASAN MASOOD
Title or Position: OWNER
Credential: DPM
Phone: 845-536-8826