Provider Demographics
NPI:1588239958
Name:MUJTABA WOMEN'S HEALTH MIDWIFERY PC
Entity Type:Organization
Organization Name:MUJTABA WOMEN'S HEALTH MIDWIFERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AYESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUJTABA
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:718-219-2400
Mailing Address - Street 1:10426 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2328
Mailing Address - Country:US
Mailing Address - Phone:718-219-2400
Mailing Address - Fax:
Practice Address - Street 1:10426 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2328
Practice Address - Country:US
Practice Address - Phone:718-219-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty