Healthcare Provider Details

I. General information

NPI: 1730531286
Provider Name (Legal Business Name): DR. MUSTAFA FARAJ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 12/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 LAKEVIEW AVE
CLIFTON NJ
07011-4051
US

IV. Provider business mailing address

244 LAKEVIEW AVE
CLIFTON NJ
07011-4051
US

V. Phone/Fax

Practice location:
  • Phone: 973-510-0250
  • Fax: 973-510-0251
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. MUSTAFA FARAJ
Title or Position: PHARMACIST-IN-CHARGE / OWNER
Credential: B.S., PHARM.D.
Phone: 973-510-0250