Individual
PRIVILAGE MASONI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1032 VICTORY BLVD, STATEN ISLAND, NY 10301-3626
(718) 448-7543
(718) 448-0045
Mailing address
PO BOX 40769, STATEN ISLAND, NY 10304-0769
(718) 448-7543
(718) 448-0045
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
18629
MS
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
246241
NY
207RP1001X
Pulmonary Disease Physician
Primary
246241
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01284873
AMERIGROUP
NY
05
—
03079352
—
NY
01
—
090702000026
FIDELIS
NY
05
—
1110949
—
LA
01
—
246241
NEW YORK STATE LICENSE NUMBER
NY
01
—
9999999988
AFFINITY
NY
Enumeration date
06/03/2006
Last updated
04/07/2019
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