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General NPI Number Information
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NPI Number | 1427116516
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Entity Type | Individual
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Provider Name | BRUCE ANDREW MASLACK MD
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | ST MARYS HOSPITAL BEHAVIORAL HEALTH 427 GUY PARK AVENUE
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City | AMSTERDAM
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State | NY
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Zip | 12010
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Country | US
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Telephone | 518-841-7320
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Fax | 518-842-0036
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Provider Business Mailing Address
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Address Line | ST MARYS HOSPITAL BEHAVIORAL HEALTH 427 GUY PARK AVENUE
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City | AMSTERDAM
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State | NY
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Zip | 12010
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Country | US
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Telephone | 518-841-7320
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Fax | 518-842-0036
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 205722-1
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License Number State | NY
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