Provider Demographics
NPI:1962404871
Name:MASSON, JAMIE LYN (MD)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYN
Last Name:MASSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYN
Other - Last Name:GOLDFARB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:169 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4246
Mailing Address - Country:US
Mailing Address - Phone:607-798-5408
Mailing Address - Fax:518-458-2610
Practice Address - Street 1:169 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4246
Practice Address - Country:US
Practice Address - Phone:607-798-5408
Practice Address - Fax:518-438-5803
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235112207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02651343Medicaid
NY02651343Medicaid
NYH78434Medicare UPIN