Provider Demographics
NPI:1033856810
Name:MUSTAFA, SALEEM (MBBS)
Entity Type:Individual
Prefix:
First Name:SALEEM
Middle Name:
Last Name:MUSTAFA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ZUCKER SCHOOL OF MEDICINE MATHER HOSPITAL
Mailing Address - Street 2:75 NORTH COUNTRY ROAD PORT JEFFERSON
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-473-1320
Mailing Address - Fax:
Practice Address - Street 1:ZUCKER SCHOOL OF MEDICINE MATHER HOSPITAL
Practice Address - Street 2:75 NORTH COUNTRY ROAD PORT JEFFERSON
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-473-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program