Provider Demographics
NPI:1437258134
Name:MUKHTAR, MOHAMMAD JAWAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:JAWAD
Last Name:MUKHTAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4704
Mailing Address - Country:US
Mailing Address - Phone:516-536-5765
Mailing Address - Fax:516-536-5766
Practice Address - Street 1:178 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4704
Practice Address - Country:US
Practice Address - Phone:516-536-5765
Practice Address - Fax:516-536-5766
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY241969OtherLICENSE #