Provider Demographics
NPI:1285781310
Name:MASSER, HERBERT II (CSW-R)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:MASSER
Suffix:II
Gender:M
Credentials:CSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 MECKLENBURG RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9237
Mailing Address - Country:US
Mailing Address - Phone:607-273-9278
Mailing Address - Fax:607-273-6613
Practice Address - Street 1:1919 MECKLENBURG RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9237
Practice Address - Country:US
Practice Address - Phone:607-273-9278
Practice Address - Fax:607-273-6613
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039560170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01779840Medicaid
NY56846BMedicare ID - Type Unspecified