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General NPI Number Information
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NPI Number | 1639765704
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Entity Type | Organization
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Legal Business Name | MUJTABA NP IN FAMILY HEALTH, P.C.
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Dates
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Enumeration Date | 12/14/2020
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 10426 ROOSEVELT AVE
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City | CORONA
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State | NY
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Zip | 11368-2328
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Country | US
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Telephone | 718-533-0991
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Fax | 833-969-0190
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Provider Business Mailing Address
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Address Line | 10426 ROOSEVELT AVE
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City | CORONA
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State | NY
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Zip | 11368-2328
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Country | US
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Telephone | 917-982-5007
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Fax |
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Authorized Official
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Title or Position | CEO/PROVIDER
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Name | MR. ATHAR MUJTABA
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Credential | NP
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Telephone | 917-982-5007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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