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NPI Code Detail

MEDICARE: DR. NELLY MARIA MASEDA M.D.

MEDICARE: DR. NELLY MARIA MASEDA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician180271NY
2208000000XPediatrics Physician182271NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063410041
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NELLY MARIA MASEDA M.D.
Provider Business Mailing Address
First Line : 1225 GERARD AVE FL 2
Second Line :
City : BRONX
State : NY
Zip : 10452-8015
Country : US
Telephone Number : 718-960-2777
Fax Number : 718-960-2912
Provider Business Practice Location Address
First Line : 1225 GERARD AVE FL 2
Second Line :
City : BRONX
State : NY
Zip : 10452-8015
Country : US
Telephone Number : 718-960-2777
Fax Number : 187-960-2912
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 09/12/2023

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