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General NPI Number Information
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NPI Number | 1376785626
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Entity Type | Organization
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Legal Business Name | MUSTAFA SIDALI DO PC
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 380 UNION AVE
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City | BELLEVILLE
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State | NJ
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Zip | 07109-2122
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Country | US
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Telephone | 973-759-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 380 UNION AVE
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City | BELLEVILLE
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State | NJ
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Zip | 07109-2122
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Country | US
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Telephone | 973-759-4411
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MUSTAFA M SIDALI
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Credential | DO
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Telephone | 973-759-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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