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General NPI Number Information
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NPI Number | 1710130018
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Entity Type | Organization
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Legal Business Name | JOSEPH B MASTERNICK DO INC
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 05/03/2010
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Provider Practice Location Address
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Address Line | 914 TRAILWOOD DR
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City | BOARDMAN
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State | OH
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Zip | 44512-5007
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Country | US
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Telephone | 330-758-4568
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Fax | 330-758-5683
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Provider Business Mailing Address
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Address Line | PO BOX 14290
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City | POLAND
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State | OH
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Zip | 44514-7290
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Country | US
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Telephone | 330-758-4568
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Fax | 330-758-5683
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LORETTA BURNICH
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Credential |
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Telephone | 330-758-4568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 34-00-2093
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License Number State | OH
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