Healthcare Provider Details

I. General information

NPI: 1003494121
Provider Name (Legal Business Name): NICHOLAS ANTHONY MUSACCHIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 W 53RD ST FL 1
NEW YORK NY
10019-5807
US

IV. Provider business mailing address

262 W 53RD ST FL 1
NEW YORK NY
10019-5807
US

V. Phone/Fax

Practice location:
  • Phone: 212-641-4500
  • Fax:
Mailing address:
  • Phone: 212-641-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number341542
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: