Provider Demographics
NPI:1629757323
Name:MUJTABA NP WALK IN CLINIC, PC
Entity Type:Organization
Organization Name:MUJTABA NP WALK IN CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ASSAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MUJTABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-310-9066
Mailing Address - Street 1:859 CLIFTON AVE STE H
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1715
Mailing Address - Country:US
Mailing Address - Phone:973-310-9066
Mailing Address - Fax:
Practice Address - Street 1:2123 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047
Practice Address - Country:US
Practice Address - Phone:201-272-1619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUJTABA NP WALK IN CLINIC PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty