Basic Information
| Provider Information | |||||||||
| NPI: | 1538426804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUSHI | ||||||||
| FirstName: | ISRAEL | ||||||||
| MiddleName: | SK | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2804 SOUTHAMPTON RD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191541207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156770930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1684 DIXWELL AVE | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065143111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037877191 | ||||||||
| FaxNumber: | 2037877191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2012 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA053295 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.