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General NPI Number Information
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NPI Number | 1154862506
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Entity Type | Individual
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Provider Name | MARIANA MUSSA
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Gender | Female
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Dates
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Enumeration Date | 03/18/2017
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Last Update Date | 03/18/2017
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Provider Practice Location Address
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Address Line | 439 PORT RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10302-1714
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Country | US
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Telephone | 917-830-0838
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Fax |
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Provider Business Mailing Address
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Address Line | 58 LOCUST AVE
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City | NORTH ARLINGTON
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State | NJ
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Zip | 07031-5513
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Country | US
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Telephone | 201-927-8185
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 0287431
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License Number State | NY
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