MEDICARE: HEBA MOUSTAFA

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	225100000X	Physical Therapist	045724	NY

General Provider Information

NPI Number	:	1811521735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEBA MOUSTAFA

Provider Business Mailing Address
First Line	:	500 SUMMIT AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2946
Country	:	US
Telephone Number	:	781-606-1018
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 SUMMIT AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2946
Country	:	US
Telephone Number	:	781-606-1018
Fax Number	:

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

Provider Enumeration Date	:	02/29/2020
Last Update Date	:	02/29/2020

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Directions to “ HEBA MOUSTAFA ” Practice Location

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