Provider Demographics
NPI:1275668055
Name:MUSTO, ELIZABETH MARY (FNPC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARY
Last Name:MUSTO
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1113 RHINELANDER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1309
Mailing Address - Country:US
Mailing Address - Phone:718-792-2123
Mailing Address - Fax:718-828-0145
Practice Address - Street 1:1 PENN PLZ FL 8
Practice Address - Street 2:OPTUM
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0899
Practice Address - Country:US
Practice Address - Phone:347-219-0784
Practice Address - Fax:212-216-6606
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331529363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY98V361OtherMEDICARE ID
NY1917624Medicaid
NY1917624Medicaid