Active NPI
Robert A Mustillo, M.D.
- Sports Medicine (Internal Medicine) Physician
- Newark, NJ
National Provider Identifier
1649470295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Internal Medicine) Physician
- License
- MA053782
- Practice address
- 221 Chestnut St
Newark, NJ 07105-1558 - Phone
- (973) 878-3990
- NPI assigned
- Jul 23, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Medical Examiner Physician | 202C00000X | MA053782 | NJ | |
| Neuromusculoskeletal Medicine & OMM Physician | 204D00000X | MA053782 | NJ | |
| Sports Medicine (Internal Medicine) Physician | 207RS0010X | MA053782 | NJ | Primary |
Addresses
Primary practice location
221 Chestnut St
Newark, NJ 07105-1558
Mailing address
221 Chestnut St
Newark, NJ 07105-1558
Phone (973) 878-3990
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA053782 | NJ | MD | Sports Medicine (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211328000000",
"number": "1649470295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "221 CHESTNUT ST",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071051558",
"telephone_number": "973-878-3990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 CHESTNUT ST",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071051558",
"telephone_number": "973-878-3990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUSTILLO",
"first_name": "ROBERT",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-23",
"last_updated": "2008-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "202C00000X",
"taxonomy_group": "",
"desc": "Independent Medical Examiner",
"state": "NJ",
"license": "MA053782",
"primary": false
},
{
"code": "204D00000X",
"taxonomy_group": "",
"desc": "Neuromusculoskeletal Medicine & OMM",
"state": "NJ",
"license": "MA053782",
"primary": false
},
{
"code": "207RS0010X",
"taxonomy_group": "",
"desc": "Internal Medicine, Sports Medicine",
"state": "NJ",
"license": "MA053782",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.