Basic Information
Provider Information
NPI: 1033556253
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MUSYT
FirstName: JONATHAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1030 NEW HOLLAND AVE
Address2:  
City: LANCASTER
State: PA
PostalCode: 176015690
CountryCode: US
TelephoneNumber: (717) 738-0660
FaxNumber: 7177380658
Practice Location
Address1: 1635 W MAIN ST STE 700
Address2:  
City: EPHRATA
State: PA
PostalCode: 175221147
CountryCode: US
TelephoneNumber: 7177380660
FaxNumber: 7177380658
Other Information
ProviderEnumerationDate: 05/29/2013
LastUpdateDate: 06/14/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD457772PAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


Home