MEDICARE: KHALED 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	163W00000X	Registered Nurse	840627	NY

General Provider Information

NPI Number	:	1902754914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHALED MOUSTAFA

Provider Business Mailing Address
First Line	:	1750 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5623
Country	:	US
Telephone Number	:	646-886-6092
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5623
Country	:	US
Telephone Number	:	646-886-6092
Fax Number	:

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “ KHALED MOUSTAFA ” Practice Location

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