Provider Demographics
NPI:1689790669
Name:EL KHASHAB, MOSTAFA ALY (MD)
Entity Type:Individual
Prefix:DR
First Name:MOSTAFA
Middle Name:ALY
Last Name:EL KHASHAB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3600 RTE 66
Mailing Address - Street 2:3RD FL
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2645
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:
Practice Address - Street 1:201 ROUTE 17
Practice Address - Street 2:5TH FLOOR
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2574
Practice Address - Country:US
Practice Address - Phone:201-457-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2023-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08267800207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ205229077Medicare UPIN