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General NPI Number Information
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NPI Number | 1568189322
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Entity Type | Individual
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Provider Name | SCOTT CARMINE MASULLO SR. NP
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Gender | Male
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 382 W PASSAIC AVE
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-5554
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Country | US
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Telephone | 973-338-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 154 WATCHUNG PL
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City | NUTLEY
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State | NJ
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Zip | 07110-2031
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Country | US
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Telephone | 973-943-7333
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ01370400
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License Number State | NJ
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