Provider Demographics
NPI:1699199489
Name:MUSCARELLO, MARY (NP, CDE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MUSCARELLO
Suffix:
Gender:F
Credentials:NP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SAINT ANDREWS LN
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2254
Mailing Address - Country:US
Mailing Address - Phone:516-674-7324
Mailing Address - Fax:516-674-1905
Practice Address - Street 1:101 SAINT ANDREWS LN
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2254
Practice Address - Country:US
Practice Address - Phone:516-674-7324
Practice Address - Fax:516-674-1905
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7838635163WD0400X
NYF307880363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator