Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | MA053782 | NJ |
NPI | 1649470295 |
---|---|
Provider Name | Dr. Robert A Mustillo |
First Address | Newark, NJ 07105-1558 |
Second Address | Newark, NJ 07105-1558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 21/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E55343 | (02) | NJ |