Basic Information
Provider Information
NPI: 1033556972
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MASYGA
FirstName: NICHOLAS
MiddleName: PATRICK
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 908 NIAGARA FALLS BLVD
Address2: SUITE 208
City: NORTH TONAWANDA
State: NY
PostalCode: 141202019
CountryCode: US
TelephoneNumber: 7166923302
FaxNumber: 7162130348
Practice Location
Address1: 517 SUNSET DR
Address2:  
City: HAMBURG
State: NY
PostalCode: 140754231
CountryCode: US
TelephoneNumber: 7166462590
FaxNumber: 7166462593
Other Information
ProviderEnumerationDate: 06/02/2013
LastUpdateDate: 09/23/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X284905NYY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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