Healthcare Provider Details

I. General information

NPI: 1265428965
Provider Name (Legal Business Name): DAVID C MUELLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 LAFAYETTE RD RT 15 SO SUITE 101
SPARTA NJ
07871
US

IV. Provider business mailing address

376 LAFAYETTE RD RT 15 SO SUITE 101
SPARTA NJ
07871
US

V. Phone/Fax

Practice location:
  • Phone: 973-579-3173
  • Fax: 973-579-2961
Mailing address:
  • Phone: 973-579-3173
  • Fax: 973-579-2961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD002672
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: