Provider Demographics
NPI:1174572713
Name:MASUR, MILTON (MD)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:MASUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:70 GLEN COVE RD
Mailing Address - Street 2:STE 301
Mailing Address - City:ROSLYN HGTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1726
Mailing Address - Country:US
Mailing Address - Phone:516-621-1502
Mailing Address - Fax:516-621-1162
Practice Address - Street 1:70 GLEN COVE RD
Practice Address - Street 2:STE 301
Practice Address - City:ROSLYN HGTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1726
Practice Address - Country:US
Practice Address - Phone:516-621-1502
Practice Address - Fax:516-621-1162
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY92244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC09357Medicare UPIN
NY4348214511Medicare PIN