MEDICARE: PRIVILAGE MASONI 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
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	18629	MS
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	246241	NY
3	207RP1001X	Pulmonary Disease Physician	246241	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	246241	OTHER	NY	NEW YORK STATE LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	01284873	OTHER	NY	AMERIGROUP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	090702000026	OTHER	NY	FIDELIS
6	9999999988	OTHER	NY	AFFINITY

General Provider Information

NPI Number	:	1326086216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIVILAGE MASONI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 40769
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-0769
Country	:	US
Telephone Number	:	718-448-7543
Fax Number	:	718-448-0045

Provider Business Practice Location Address
First Line	:	1032 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3626
Country	:	US
Telephone Number	:	718-448-7543
Fax Number	:	718-448-0045

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	04/07/2019

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Directions to “ PRIVILAGE MASONI M.D.” Practice Location

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