Provider Demographics
NPI:1699471375
Name:MASON, LAURAE R
Entity type:Individual
Prefix:MRS
First Name:LAURAE
Middle Name:R
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 LAFAYETTE AVE APT 18A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1433
Mailing Address - Country:US
Mailing Address - Phone:646-806-6001
Mailing Address - Fax:
Practice Address - Street 1:1269 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3203
Practice Address - Country:US
Practice Address - Phone:718-384-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist