Provider Demographics
NPI:1184084436
Name:MUSA, NICHOLAS GIOVANNI
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GIOVANNI
Last Name:MUSA
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 1:10 ADAM LABAR RD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18302-8872
Mailing Address - Country:US
Mailing Address - Phone:570-369-3231
Mailing Address - Fax:
Practice Address - Street 1:10 ADAM LABAR RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18302-8872
Practice Address - Country:US
Practice Address - Phone:570-369-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer