Provider Demographics
NPI:1275230351
Name:MUSTAFA QAWASMEH, LLC
Entity Type:Organization
Organization Name:MUSTAFA QAWASMEH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:QAWASMEH
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:347-679-5234
Mailing Address - Street 1:1957 BRONXDALE AVE APT B25
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3399
Mailing Address - Country:US
Mailing Address - Phone:347-679-5234
Mailing Address - Fax:
Practice Address - Street 1:1957 BRONXDALE AVE APT B25
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3399
Practice Address - Country:US
Practice Address - Phone:347-679-5234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency