=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407830821
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BIMAL MASSAND MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 MONTAUK HWY
-----------------------------------------------------
City | WEST ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-376-4088
-----------------------------------------------------
Fax | 631-376-3289
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 BOYLE RD
-----------------------------------------------------
City | SELDEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-736-3372
-----------------------------------------------------
Fax | 631-736-1332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 187539
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------