Provider Demographics
NPI:1104295328
Name:AWAKEN YOUR MASTERY
Entity type:Organization
Organization Name:AWAKEN YOUR MASTERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-393-1991
Mailing Address - Street 1:141 S BLACK HORSE PIKE
Mailing Address - Street 2:STE 104
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2975
Mailing Address - Country:US
Mailing Address - Phone:856-393-1991
Mailing Address - Fax:
Practice Address - Street 1:141 S BLACK HORSE PIKE
Practice Address - Street 2:STE 104
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2975
Practice Address - Country:US
Practice Address - Phone:856-393-1991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty