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General NPI Number Information
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NPI Number | 1891442224
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Entity Type | Individual
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Provider Name | WILLIAM MUGISA
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Gender | Male
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Dates
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Enumeration Date | 03/06/2022
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Last Update Date | 03/06/2022
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Provider Practice Location Address
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Address Line | 1 BROOKDALE PLZ
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City | BROOKLYN
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State | NY
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Zip | 11212-3139
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Country | US
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Telephone | 718-240-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 412 OCEAN VIEW AVE
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City | BROOKLYN
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State | NY
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Zip | 11235-7073
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Country | US
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Telephone | 718-801-7468
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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 | F403825-01
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License Number State | NY
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