Basic Information
| Provider Information | |||||||||
| NPI: | 1578899340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUELLER | ||||||||
| FirstName: | ELISABETH | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2564 32ND ST | ||||||||
| Address2: | APT. 2 | ||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111021744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165518401 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8956 162ND ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114325072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186577100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2009 | ||||||||
| LastUpdateDate: | 11/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.