Provider Demographics
NPI:1245497007
Name:GEORGE V. MUSCATO JR., M.D., P.C.
Entity type:Organization
Organization Name:GEORGE V. MUSCATO JR., M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-434-1149
Mailing Address - Street 1:229 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-3812
Mailing Address - Country:US
Mailing Address - Phone:716-434-1149
Mailing Address - Fax:716-434-4362
Practice Address - Street 1:229 EAST AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-3812
Practice Address - Country:US
Practice Address - Phone:716-434-1149
Practice Address - Fax:716-434-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070966208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00658791Medicaid
RA1204Medicare PIN
B71282Medicare UPIN
BA0134Medicare PIN