MEDICARE: DR. TANZIA MUSTAFA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	230080	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194801308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANZIA MUSTAFA MD

Provider Business Mailing Address
First Line	:	2349 81ST ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1620
Country	:	US
Telephone Number	:	646-386-6220
Fax Number	:	917-832-6598

Provider Business Practice Location Address
First Line	:	8107 ASTORIA BLVD
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370
Country	:	US
Telephone Number	:	646-386-6220
Fax Number	:	917-832-6598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	08/10/2021

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