Provider Demographics
NPI:1811939085
Name:MUSSO, JOSEPH L (FACC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:MUSSO
Suffix:
Gender:M
Credentials:FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 07 156 AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414
Mailing Address - Country:US
Mailing Address - Phone:718-641-7180
Mailing Address - Fax:718-641-7326
Practice Address - Street 1:94 07 156 AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414
Practice Address - Country:US
Practice Address - Phone:718-641-7180
Practice Address - Fax:718-641-7326
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211908207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07936GMedicare PIN
NYI05776Medicare UPIN
NYP00373299Medicare PIN