Basic Information
| Provider Information | |||||||||
| NPI: | 1295810596 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASSEY | ||||||||
| FirstName: | DONI | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PITCHFORD | ||||||||
| OtherFirstName: | DONI | ||||||||
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| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14616 LINDEN BLVD | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114361124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189202966 | ||||||||
| FaxNumber: | 7186531587 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 DELAWARE DR STE 205 | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166226088 | ||||||||
| FaxNumber: | 5166226082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 005906 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.