Provider Demographics
NPI:1356584239
Name:EMILIO MUSSO MD PA
Entity type:Organization
Organization Name:EMILIO MUSSO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:S
Authorized Official - Last Name:MUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-427-0860
Mailing Address - Street 1:2055 MILITARY TRL
Mailing Address - Street 2:SUITE 303
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7801
Mailing Address - Country:US
Mailing Address - Phone:561-427-0860
Mailing Address - Fax:561-427-0870
Practice Address - Street 1:2055 MILITARY TRL
Practice Address - Street 2:SUITE 303
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7801
Practice Address - Country:US
Practice Address - Phone:561-427-0860
Practice Address - Fax:561-427-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0057954207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty