Healthcare Provider Details

I. General information

NPI: 1659798064
Provider Name (Legal Business Name): MARTIN MASSLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 NEW STREET
WEST PAWLET VT
05775
US

IV. Provider business mailing address

67 NORWOOD AVE
GLEN ROCK NJ
07452-1429
US

V. Phone/Fax

Practice location:
  • Phone: 201-247-6003
  • Fax:
Mailing address:
  • Phone: 201-444-5874
  • Fax: 201-444-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number098.0000166
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: