Healthcare Provider Details

I. General information

NPI: 1902195993
Provider Name (Legal Business Name): HUSSEIN ABDULLA MUSTAFA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7404
US

IV. Provider business mailing address

803 BERKSHIRE VALLEY RD
WHARTON NJ
07885-1511
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA08884900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: