Healthcare Provider Details

I. General information

NPI: 1700741113
Provider Name (Legal Business Name): AL MOWAFY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 ADAMS ST
OLD BRIDGE NJ
08857-2112
US

IV. Provider business mailing address

34 ADAMS ST
OLD BRIDGE NJ
08857-2112
US

V. Phone/Fax

Practice location:
  • Phone: 718-490-7260
  • Fax:
Mailing address:
  • Phone: 718-490-7260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37FA00057100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: