Individual
MR. PAUL MASTROROCCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DISPENSING OPTICIAN
Contact information
Practice address
208 ROUTE 112 STE 2, PORT JEFFERSON STATION, NY 11776-1013
(631) 331-0600
(631) 331-0809
Mailing address
180 E MAIN ST, SUITE 104, PATCHOGUE, NY 11772-3171
(631) 475-5030
(631) 475-5037
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
5855-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00342952
—
NY
05
—
00683849
—
NY
05
—
01934578
—
NY
05
—
03292940
—
NY
Enumeration date
11/18/2008
Last updated
09/17/2021
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