Healthcare Provider Details

I. General information

NPI: 1619979879
Provider Name (Legal Business Name): JOSEPHINE D MUSTO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 5TH AVE # 1AB
NEW YORK NY
10003-4319
US

IV. Provider business mailing address

41 5TH AVE 1A
NEW YORK NY
10003-4319
US

V. Phone/Fax

Practice location:
  • Phone: 212-604-1300
  • Fax: 212-604-1399
Mailing address:
  • Phone: 212-604-1300
  • Fax: 212-604-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33-334339
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: