Provider Demographics
NPI:1063437200
Name:MASSEY, BETH M (DO)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:M
Last Name:MASSEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:126 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3510
Mailing Address - Country:US
Mailing Address - Phone:516-731-0303
Mailing Address - Fax:
Practice Address - Street 1:2900 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 203
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1404
Practice Address - Country:US
Practice Address - Phone:516-731-0303
Practice Address - Fax:516-731-6302
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194285204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF99102Medicare UPIN
NY107841Medicare PIN