MEDICARE: LARISA MASHENSKY MD

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
1	207R00000X	Internal Medicine Physician	223084	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	113465674	OTHER	NY	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134181373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARISA MASHENSKY MD

Provider Business Mailing Address
First Line	:	1003 HAMPTON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3013
Country	:	US
Telephone Number	:	347-401-8476
Fax Number	:	718-998-9059

Provider Business Practice Location Address
First Line	:	50 E 42ND ST
Second Line	:	SUITE#200
City	:	NEW YORK
State	:	NY
Zip	:	10017-5405
Country	:	US
Telephone Number	:	212-867-0405
Fax Number	:	212-867-0409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	08/20/2008

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