Provider Demographics
NPI:1992705602
Name:MASI, VICTOR J (DO)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:J
Last Name:MASI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 COURT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4331
Mailing Address - Country:US
Mailing Address - Phone:718-625-5449
Mailing Address - Fax:718-625-3189
Practice Address - Street 1:376 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4331
Practice Address - Country:US
Practice Address - Phone:718-625-5449
Practice Address - Fax:718-625-3189
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198455207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
761871Medicare ID - Type Unspecified
G26998Medicare UPIN