Healthcare Provider Details

I. General information

NPI: 1013449057
Provider Name (Legal Business Name): MOHAMMAD HASHIM MUSTEHSAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE ROAD
WARWICK RI
02886
US

IV. Provider business mailing address

111 E 210TH ST
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-7010
  • Fax: 401-736-1973
Mailing address:
  • Phone: 516-322-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1019114
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD19961
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: