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General NPI Number Information
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NPI Number | 1104293661
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Entity Type | Individual
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Provider Name | KAITLIN ELIZABETH MASCIELLO PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 111 E 210TH ST
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City | BRONX
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State | NY
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Zip | 10467-2401
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Country | US
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Telephone | 718-920-4361
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Fax |
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Provider Business Mailing Address
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Address Line | 331 NEWMAN SPRINGS ROAD BLDG. 2, SUITE 220
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City | RED BANK
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State | NJ
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Zip | 07701
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Country | US
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Telephone | 732-807-0877
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Fax | 201-751-1680
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 018998
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License Number State | NY
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