Individual
MR. PAUL MASTROROCCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DISPENSING OPTICIAN
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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