Basic Information
| Provider Information | |||||||||
| NPI: | 1205141959 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASON | ||||||||
| FirstName: | MATILDA | ||||||||
| MiddleName: | SYLVIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ANDOH | ||||||||
| OtherFirstName: | MATILDA | ||||||||
| OtherMiddleName: | SYLVIA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 22 BAY VIEW TER | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144569768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157597119 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | HSC T16-020 | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314448478 | ||||||||
| FaxNumber: | 6314447546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2010 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA09712200 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 268687 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.