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General NPI Number Information
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NPI Number | 1194706614
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Entity Type | Individual
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Provider Name | RAUL JOSE MASAKAYAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 32 SETALCOTT PL
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City | SETAUKET
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State | NY
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Zip | 11733-1326
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Country | US
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Telephone | 631-246-9276
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Fax |
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Provider Business Mailing Address
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Address Line | 32 SETALCOTT PL
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City | SETAUKET
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State | NY
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Zip | 11733-1326
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Country | US
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Telephone | 631-848-3155
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 211412
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License Number State | NY
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