Provider Demographics
NPI:1326292202
Name:ADVANCED PHYSICIAN SERVICES PC
Entity Type:Organization
Organization Name:ADVANCED PHYSICIAN SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-641-7180
Mailing Address - Street 1:9407 156TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2826
Mailing Address - Country:US
Mailing Address - Phone:718-641-7180
Mailing Address - Fax:718-641-7326
Practice Address - Street 1:9407 156TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2826
Practice Address - Country:US
Practice Address - Phone:718-641-7180
Practice Address - Fax:718-641-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY211908OtherLICENSE