MEDICARE: MINIMALLY INVASIVE FOOT & ANKLE SPECIALIST

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	261QM2500X	Medical Specialty Clinic/Center
2	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1609530005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINIMALLY INVASIVE FOOT & ANKLE SPECIALIST

Provider Business Mailing Address
First Line	:	275 BRANDYWINE DR
Second Line	:
City	:	ORANGEBURG
State	:	NY
Zip	:	10962-2602
Country	:	US
Telephone Number	:	845-536-8826
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 MAMARONECK AVE STE 310
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-1316
Country	:	US
Telephone Number	:	914-222-0115
Fax Number	:	702-852-0631

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HASAN MASOOD
Credential	:	DPM
Telephone Number	:	845-536-8826

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	01/19/2024

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