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DR. ADELAIDE LU MASAKAYAN M.D.
NPI 1902970577
Pediatrics in Port Jefferson Station, NY

Active since November 17, 2006CLIA 33D1014992 · Waiver
112 TERRYVILLE RD, PORT JEFFERSON STATION, NY 11776(631) 209-2827(631) 209-2829 Get Directions Write a Review

NPPES record last updated: March 16, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Adelaide Lu Masakayan M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ADELAIDE LU MASAKAYAN M.D. (NPI 1902970577) is an individual pediatrics provider in Port Jefferson Station, New York, licensed in New York (210204) and active in the NPI registry since November 2006. She holds a CLIA Waiver certificate valid through July 21, 2027.

NPPES Registry Identity

NPI1902970577
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameDR. ADELAIDE LU MASAKAYANCredential: M.D.
Location Address112 TERRYVILLE RDPort Jefferson Station, NY 11776-1329
Mailing Address112 Terryville RdPort Jefferson Station, NY 11776-1329 · (631) 209-2827 · Fax (631) 209-2829
Phone(631) 209-2827
Fax(631) 209-2829
Sole ProprietorYes
Enumeration DateNovember 17, 2006
Last NPPES UpdateMarch 16, 2016
✔ NPI 1902970577 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in NY · 210204
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
112 TERRYVILLE RD, Port Jefferson Station, NY 11776
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Other Identifiers 1

Medicare UPING16876NY

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D1014992

Adelaide L Masakayan MD Pediatrics PC · Port Jefferson Station, NY
Active · expires Jul 21, 2027
CLIA Number33D1014992
Laboratory TypePhysician Office
Certificate Effective DateJuly 22, 2025
Certificate Expiration DateJuly 21, 2027
Laboratory DirectorDr. Adelaide L. Masakayan
Laboratory Phone(631) 209-2827
Laboratory LocationAdelaide L Masakayan MD Pediatrics PC112 Terryville Road, Port Jefferson Station, NY 11776
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMANDA FOY
Physician Assistant
112 TERRYVILLE RD
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 209-2827
DR. JOHN J RICCIARDELLI M.D.
Internal Medicine
112 TERRYVILLE RD
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 473-3900
MS. BRENNA KATHERINE BUCKSTEIN MSPAS, PA-C
Physician Assistant
112 TERRYVILLE RD
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 209-2827
JENNA MARIE CANDEMERES CPNP-PC
Nurse Practitioner (Pediatrics)
112 TERRYVILLE RD
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 209-2827

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Adelaide Masakayan's NPI number?

The NPI number for Adelaide Masakayan is 1902970577. It was assigned to this individual provider in the NPPES registry on November 17, 2006.

Where is Adelaide Masakayan located?

Adelaide Masakayan practices at 112 Terryville Rd, Port Jefferson Station, NY 11776. The listed phone number is (631) 209-2827.

What is Adelaide Masakayan's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Adelaide Masakayan hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D1014992) is associated with this NPI, valid through July 21, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Adelaide Masakayan was last updated on March 16, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.