MEDICARE: DR. KRISTINE MASCARINAS D.O.

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	207P00000X	Emergency Medicine Physician	25MB09252800	NJ
2	207P00000X	Emergency Medicine Physician	OS16360	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1427288109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINE MASCARINAS D.O.

Provider Business Mailing Address
First Line	:	703 MAIN ST
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07503-2621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14150 SW 136TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-5506
Country	:	US
Telephone Number	:	786-204-4600
Fax Number	:

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

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	03/18/2020

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