Provider Demographics
NPI:1548261407
Name:MUSTO, RICHARD V (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:V
Last Name:MUSTO
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 1:250 YAPHANK RD
Mailing Address - Street 2:STE 11B
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4800
Mailing Address - Country:US
Mailing Address - Phone:631-475-5051
Mailing Address - Fax:
Practice Address - Street 1:250 YAPHANK RD
Practice Address - Street 2:STE 11B
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4800
Practice Address - Country:US
Practice Address - Phone:631-475-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108812208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0094278OtherGHI
NY218607POtherHIP
NY940046752OtherPHCS
NY00628515-8Medicaid
NYCS1074OtherOXFORD
NY1900113OtherUNITED HEALTHCARE
NY325951OtherEMPIRE BCBS
NY340004363OtherRAILROAD MEDICARE
NY952383OtherHEALTHNET
NY1604OtherVYTRA
NY4283400OtherAETNA
NY5610409006OtherHEALTHCARE PARTNERS
NY6510409007OtherCIGNA
NY940046752OtherPHCS
NYB13043Medicare UPIN