Healthcare Provider Details

I. General information

NPI: 1801705678
Provider Name (Legal Business Name): THOMAS MUSTACCHIA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 SEAVIEW AVE
STATEN ISLAND NY
10305-3409
US

IV. Provider business mailing address

1170 78TH ST
BROOKLYN NY
11228-2624
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-2300
  • Fax:
Mailing address:
  • Phone: 929-466-2487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberN48836
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: