Provider Demographics
NPI:1427116516
Name:MASLACK, BRUCE ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ANDREW
Last Name:MASLACK
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ST MARYS HOSPITAL BEHAVIORAL HEALTH
Mailing Address - Street 2:427 GUY PARK AVENUE
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-841-7320
Mailing Address - Fax:518-842-0036
Practice Address - Street 1:ST MARYS HOSPITAL BEHAVIORAL HEALTH
Practice Address - Street 2:427 GUY PARK AVENUE
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010
Practice Address - Country:US
Practice Address - Phone:518-841-7320
Practice Address - Fax:518-842-0036
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY205722-1207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01885432Medicaid
E54951Medicare UPIN
NY01885432Medicaid