Healthcare Provider Details

I. General information

NPI: 1184684045
Provider Name (Legal Business Name): GHULAM MUSTAFA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SOUTH MAIN STREET
ALBION NY
14411
US

IV. Provider business mailing address

210 SOUTH MAIN STREET
ALBION NY
14411
US

V. Phone/Fax

Practice location:
  • Phone: 585-589-7874
  • Fax: 585-589-2958
Mailing address:
  • Phone: 585-589-7874
  • Fax: 585-589-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number001051
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number001051
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02069961
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier1210914
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerINDEPENDENT HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: