Provider Demographics
NPI:1538338199
Name:MASOR, HARVEY G (MD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:G
Last Name:MASOR
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 1:739 CHANCELLOR AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-2953
Mailing Address - Country:US
Mailing Address - Phone:973-371-5959
Mailing Address - Fax:973-371-0171
Practice Address - Street 1:739 CHANCELLOR AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2953
Practice Address - Country:US
Practice Address - Phone:973-371-5959
Practice Address - Fax:973-371-0171
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02102900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1D 1727702Medicaid
NJ121494Medicare PIN
NJ481025XU8Medicare PIN
NJ1D 1727702Medicaid