Provider Demographics
NPI:1609430131
Name:MUSHLIT, MONICA (LPN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MUSHLIT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:MORGIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:7 SOUTHGATE RD APT 13
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2048
Mailing Address - Country:US
Mailing Address - Phone:845-544-6331
Mailing Address - Fax:
Practice Address - Street 1:5 STEAMBOAT DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462-4524
Practice Address - Country:US
Practice Address - Phone:845-544-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167133164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1609430131Medicaid