Provider Demographics
NPI:1588107452
Name:MASTER FASTER
Entity type:Organization
Organization Name:MASTER FASTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GELB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-477-5000
Mailing Address - Street 1:105 SCHUNNEMUNK RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-6104
Mailing Address - Country:US
Mailing Address - Phone:845-477-5000
Mailing Address - Fax:
Practice Address - Street 1:105 SCHUNNEMUNK RD
Practice Address - Street 2:SUITE 112
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-6104
Practice Address - Country:US
Practice Address - Phone:845-477-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP04443251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health