Provider Demographics
NPI:1699948356
Name:MASOOD, RAJA ASIF (MD)
Entity type:Individual
Prefix:
First Name:RAJA
Middle Name:ASIF
Last Name:MASOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 DONGAN HILLS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2206
Mailing Address - Country:US
Mailing Address - Phone:718-898-3643
Mailing Address - Fax:718-989-6995
Practice Address - Street 1:343 DONGAN HILLS AVE
Practice Address - Street 2:STATEN ISLAND UNIVERSITY HOSPITAL
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2206
Practice Address - Country:US
Practice Address - Phone:718-226-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257739207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03040420Medicaid
NYA400053134Medicare PIN
NY03040420Medicaid