Provider Demographics
NPI:1487762019
Name:MASSON, LALITHA (MD, PA)
Entity type:Individual
Prefix:DR
First Name:LALITHA
Middle Name:
Last Name:MASSON
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4906
Mailing Address - Country:US
Mailing Address - Phone:201-963-8554
Mailing Address - Fax:201-222-0895
Practice Address - Street 1:506 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4906
Practice Address - Country:US
Practice Address - Phone:201-963-8554
Practice Address - Fax:201-222-0895
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA246833174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1476408Medicaid
NJ1476408Medicaid