Provider Demographics
NPI:1245232214
Name:MUSELLA, ALBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:MUSELLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 PENINSULA BLVD
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1125
Mailing Address - Country:US
Mailing Address - Phone:516-295-4740
Mailing Address - Fax:516-295-2870
Practice Address - Street 1:1100 PENINSULA BLVD
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1125
Practice Address - Country:US
Practice Address - Phone:516-295-4740
Practice Address - Fax:516-295-2870
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3778213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT51168Medicare UPIN
NYP38591Medicare ID - Type Unspecified