Provider Demographics
NPI:1235874173
Name:ALI, MUSTAFA SHOAIB (MBBS)
Entity Type:Individual
Prefix:MR
First Name:MUSTAFA
Middle Name:SHOAIB
Last Name:ALI
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 1:75 NORTH COUNTRY ROAD
Mailing Address - Street 2:MATHER HOSPITAL
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-686-2549
Mailing Address - Fax:631-686-7651
Practice Address - Street 1:75 NORTH COUNTRY ROAD
Practice Address - Street 2:MATHER HOSPITAL
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-686-2549
Practice Address - Fax:631-686-7651
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program