Provider Demographics
NPI:1376585547
Name:MUSSO, MARIA NELLA (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:NELLA
Last Name:MUSSO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 07 156 AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414
Mailing Address - Country:US
Mailing Address - Phone:718-641-7180
Mailing Address - Fax:718-641-7326
Practice Address - Street 1:94 07 156 AVENUE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414
Practice Address - Country:US
Practice Address - Phone:718-641-7180
Practice Address - Fax:718-641-7326
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF98521Medicare UPIN
NY01672GMedicare ID - Type Unspecified