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General NPI Number Information
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NPI Number | 1285065490
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Entity Type | Organization
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Legal Business Name | MASON ESC, LLC
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Dates
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Enumeration Date | 12/13/2013
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 10512 101ST AVE
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City | OZONE PARK
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State | NY
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Zip | 11416-2703
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Country | US
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Telephone | 718-505-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 4141 51ST STREET
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City | WOODSIDE
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State | NY
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Zip | 11377
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Country | US
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Telephone | 718-505-0100
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Fax | 347-935-3678
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BENJAMIN MASON
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Credential | MD
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Telephone | 718-505-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 224032-1
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License Number State | NY
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