Provider Demographics
NPI:1891947172
Name:MUSTERA, EDMOND BENEDICT (PT)
Entity Type:Individual
Prefix:MR
First Name:EDMOND BENEDICT
Middle Name:
Last Name:MUSTERA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1627
Mailing Address - Country:US
Mailing Address - Phone:914-233-6979
Mailing Address - Fax:
Practice Address - Street 1:62 BRYANT AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1627
Practice Address - Country:US
Practice Address - Phone:914-233-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025742-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics