Individual provider Active NPI

Angela Mustac, D.C

  • Rehabilitation Chiropractor
  • Wallingford, CT
National Provider Identifier
1053457580
Registry record updated Sep 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
001627 Issued in CT
Practice address
50 S Main St
2B
Wallingford, CT 06492-4219
Phone
(203) 294-1200
Fax
(203) 294-9077
NPI assigned
Jan 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Chiropractor 111NR0400X 001627 CT Primary

Addresses

Primary practice location

50 S Main St
2B
Wallingford, CT 06492-4219

Mailing address

50 S Main St
2B
Wallingford, CT 06492-4219
Phone (203) 294-1200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
001627CTMDOptometric Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Select Orthopedics, LLC Past Accepting new patients
Greater Hartford Physical Therapy Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189641600000",
    "number": "1053457580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 S MAIN ST",
            "address_2": "2B",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064924219",
            "telephone_number": "203-294-1200",
            "fax_number": "203-294-9077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 S MAIN ST",
            "address_2": "2B",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064924219",
            "telephone_number": "203-294-1200",
            "fax_number": "203-294-9077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSTAC",
        "first_name": "ANGELA",
        "credential": "D.C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "CT",
            "license": "001627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wallingford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.