Healthcare Provider Details

I. General information

NPI: 1508945650
Provider Name (Legal Business Name): PHILIP R MUSKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 YORK AVE APT 1L
NEW YORK NY
10128-7815
US

IV. Provider business mailing address

1700 YORK AVE APT 1L
NEW YORK NY
10128-7815
US

V. Phone/Fax

Practice location:
  • Phone: 212-722-8438
  • Fax: 212-342-1115
Mailing address:
  • Phone: 212-722-8438
  • Fax: 212-342-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number124158
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number124158
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number124158
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: