Provider Demographics
NPI:1588097075
Name:MASTEROVOY, ANATOLY
Entity type:Individual
Prefix:
First Name:ANATOLY
Middle Name:
Last Name:MASTEROVOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 EAGAN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4103
Mailing Address - Country:US
Mailing Address - Phone:718-356-3917
Mailing Address - Fax:
Practice Address - Street 1:87 EAGAN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-4103
Practice Address - Country:US
Practice Address - Phone:718-356-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor