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General NPI Number Information
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NPI Number | 1821756057
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Entity Type | Individual
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Provider Name | THOMAS EDWARD MASULLO MSN, CRNP-BC
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Gender | Male
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 5901 MARKET ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3117
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Country | US
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Telephone | 610-328-2165
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Fax |
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Provider Business Mailing Address
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Address Line | 173 FERN AVE
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City | COLLINGSWOOD
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State | NJ
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Zip | 08108-1920
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Country | US
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Telephone | 856-676-2337
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP024997
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License Number State | PA
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