Healthcare Provider Details

I. General information

NPI: 1588288484
Provider Name (Legal Business Name): MUSTAFA KHALAF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 JAMES STREET
EDISON NJ
08820
US

IV. Provider business mailing address

13400 E SHEA BLVD
SCOTTSDALE AZ
85259-5499
US

V. Phone/Fax

Practice location:
  • Phone: 732-321-7010
  • Fax: 732-632-1584
Mailing address:
  • Phone: 480-301-8000
  • Fax: 732-632-1584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberP21-01440
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35874
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number75564
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number72940
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: