Kristyn Leigh Mastridge

Primary specialty

SpecialistTaxonomy code 174400000X

License

662082121 Issued in NY

Practice address

5225 Nesconset Hwy Ste 30
Port Jefferson Station, NY 11776-2060

Phone

(631) 473-4284

NPI assigned

Apr 25, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• New York Therapy Placement Services

  • Early Intervention Provider Agency
  • Port Jefferson Station, NY
  • NPI 1982060489
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366848000000",
    "number": "1144664731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 CIRCLE DR W",
            "city": "EAST PATCHOGUE",
            "state": "NY",
            "postal_code": "117724294",
            "telephone_number": "631-741-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 NESCONSET HWY STE 30",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762060",
            "telephone_number": "631-473-4284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASTRIDGE",
        "first_name": "KRISTYN",
        "middle_name": "LEIGH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-25",
        "last_updated": "2013-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "662082121",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "662081121",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "662080121",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "662079121",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "350688091",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adelaide Lu Masakayan, M.D.
• Brandon Theodore Maslosky, L.P.N.
• Jade Maslosky, REGISTERED NURSE
• Felicity Joy Masone
• Gabrielle Luisa Massucci, MS CF-SLP TSSLD
• Andrew Vincent Mastronardi, DMD
• Paul Mastrorocco, DISPENSING OPTICIAN
• Kenneth Ryan Mataragas, PA-C
• Mather Faculty Medical Affiliates, University Faculty Practice Corp
• Karen Matragrano, NP-C

• Specialist in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.