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General NPI Number Information
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NPI Number | 1114968708
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Entity Type | Individual
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Provider Name | PETER A MASELLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 603 E 187TH ST
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City | BRONX
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State | NY
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Zip | 10458-6700
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Country | US
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Telephone | 718-733-3873
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Fax | 718-733-3873
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Provider Business Mailing Address
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Address Line | 620 REISS PL APT 7G
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City | BRONX
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State | NY
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Zip | 10467-8044
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Country | US
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Telephone | 718-655-9105
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Fax | 718-733-3873
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 128671
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License Number State | NY
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