Provider Demographics
NPI:1649215989
Name:MUSTAFA, MUHAMMAD USMAN (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:USMAN
Last Name:MUSTAFA
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 1:40 FULD ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638
Mailing Address - Country:US
Mailing Address - Phone:609-396-1644
Mailing Address - Fax:609-394-9526
Practice Address - Street 1:40 FULD ST
Practice Address - Street 2:SUITE 400
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638
Practice Address - Country:US
Practice Address - Phone:609-396-1644
Practice Address - Fax:609-394-9526
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07482100207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
60033479OtherHORIZON NJ HEALTH
NJ0106151Medicaid
60033479OtherHORIZON NJ HEALTH