Basic Information
| Provider Information | |||||||||
| NPI: | 1699880682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASSEAUX | ||||||||
| FirstName: | JOY | ||||||||
| MiddleName: | ANITA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23625 COMMERCE PARK | ||||||||
| Address2: | STE 204 | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162555700 | ||||||||
| FaxNumber: | 8663968340 | ||||||||
| Practice Location | |||||||||
| Address1: | 1473 TELLER AVE | ||||||||
| Address2: | FL 2 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104578949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162555700 | ||||||||
| FaxNumber: | 8663968340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 04/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 225928 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 02758845 | 05 | NY | MEDICAID | 1450502 | 05 | LA | MEDICAID | 932T51 | 01 | NY | BCBS | OTHER | P00971869 | 01 | NY | RXR MCR | OTHER | 102217735 0001 | 05 | PA | MEDICAID | Q25928 | 05 | SC | MEDICAID | 385431 | 05 | AZ | MEDICAID | 7100060780 | 05 | KY | MEDICAID | 808585500 | 05 | ID | MEDICAID |