=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609848522
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUMMRA MASOOD O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2006
-----------------------------------------------------
Last Update Date | 03/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 W 42ND ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10036-8003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-938-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 217 BLOOMFIELD AVE
-----------------------------------------------------
City | ISELIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08830-2225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-283-0324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | VUT006948
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------