Healthcare Provider Details

I. General information

NPI: 1669336640
Provider Name (Legal Business Name): AMR MOUSTAFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07305-2180
US

IV. Provider business mailing address

3049 CRESCENT ST APT H1D6 H1D6
ASTORIA NY
11102-3229
US

V. Phone/Fax

Practice location:
  • Phone: 201-433-8900
  • Fax:
Mailing address:
  • Phone: 929-789-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04474000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: