Basic Information
Provider Information
NPI: 1770725822
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MUSTEN
FirstName: ALEC
MiddleName: E.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 829641
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191823725
CountryCode: US
TelephoneNumber: 2673705296
FaxNumber: 2152303725
Practice Location
Address1: 821 HUNTINGDON PIKE STE 150
Address2:  
City: HUNTINGDON VALLEY
State: PA
PostalCode: 190068369
CountryCode: US
TelephoneNumber: 2676276715
FaxNumber: 2676276717
Other Information
ProviderEnumerationDate: 04/02/2009
LastUpdateDate: 10/04/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/04/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XMD432721PAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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