Provider Demographics
NPI:1043297211
Name:MUSS, ELIZABETH CAROL (MD FACC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CAROL
Last Name:MUSS
Suffix:
Gender:F
Credentials:MD FACC
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MUSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD FACC
Mailing Address - Street 1:530 PARK AVE APT 9D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8058
Mailing Address - Country:US
Mailing Address - Phone:212-753-9280
Mailing Address - Fax:212-308-6293
Practice Address - Street 1:131 W 35TH ST FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2111
Practice Address - Country:US
Practice Address - Phone:646-239-7128
Practice Address - Fax:212-308-6293
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104004174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00104004-060Medicaid
NYOC1827OtherHEALTHNET
NY702251OtherEMPIRE
NYP1565958OtherOXFORD
NYEM07022510Medicare PIN
NYC11988Medicare UPIN
NY00104004-060Medicaid