Provider Demographics
NPI:1336318419
Name:MUSTAFA, ALI (DC)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:MUSTAFA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 YORK ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4014
Mailing Address - Country:US
Mailing Address - Phone:201-333-8670
Mailing Address - Fax:
Practice Address - Street 1:10509 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2014
Practice Address - Country:US
Practice Address - Phone:718-441-9390
Practice Address - Fax:718-441-1061
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor