MEDICARE: DAWID HOLAS MASTERS

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	225100000X	Physical Therapist	044791	NY

General Provider Information

NPI Number	:	1669021465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWID HOLAS MASTERS

Provider Business Mailing Address
First Line	:	6827 76TH ST
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-2826
Country	:	US
Telephone Number	:	929-525-8187
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 DIVISION AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-7105
Country	:	US
Telephone Number	:	718-253-8000
Fax Number	:

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

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	09/05/2019

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Directions to “ DAWID HOLAS MASTERS” Practice Location

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