Provider Demographics
NPI:1649316001
Name:MUSCARELLO, SUSAN ELIZABETH (LPN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:MUSCARELLO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:MUSCARELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:14 SMITH COMMONS
Mailing Address - Street 2:
Mailing Address - City:YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11980-2031
Mailing Address - Country:US
Mailing Address - Phone:631-775-6357
Mailing Address - Fax:631-775-6357
Practice Address - Street 1:14 SMITH COMMONS
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980-2031
Practice Address - Country:US
Practice Address - Phone:631-775-6357
Practice Address - Fax:631-775-6357
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175229164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse