Provider Demographics
NPI:1578846168
Name:MUSGRAVE, PARTICK
Entity Type:Individual
Prefix:
First Name:PARTICK
Middle Name:
Last Name:MUSGRAVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 E 102ND ST
Mailing Address - Street 2:APT. 7B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5924
Mailing Address - Country:US
Mailing Address - Phone:347-602-1745
Mailing Address - Fax:
Practice Address - Street 1:1630 E 102ND ST
Practice Address - Street 2:APT. 7B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5924
Practice Address - Country:US
Practice Address - Phone:347-602-1745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304765164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse