Provider Demographics
NPI:1205087434
Name:MUSSELMAN, DAVID MARTIN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARTIN
Last Name:MUSSELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1960
Mailing Address - Country:US
Mailing Address - Phone:908-542-0260
Mailing Address - Fax:908-647-5690
Practice Address - Street 1:340 KINGSLAND ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1150
Practice Address - Country:US
Practice Address - Phone:973-235-3163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07149400208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice