Provider Demographics
NPI:1598058554
Name:MOSTAFA, JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MOSTAFA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ANNA ROSE CT
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2270
Mailing Address - Country:US
Mailing Address - Phone:201-683-1133
Mailing Address - Fax:
Practice Address - Street 1:292 HERBERTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1734
Practice Address - Country:US
Practice Address - Phone:732-840-8989
Practice Address - Fax:732-840-9135
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006735213ES0103X
NJ25MD00320900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty