Provider Demographics
NPI:1699230359
Name:MUJTABA, ASSAD (DNP, NP-C)
Entity Type:Individual
Prefix:
First Name:ASSAD
Middle Name:
Last Name:MUJTABA
Suffix:
Gender:M
Credentials:DNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:866-464-3951
Practice Address - Street 1:859 CLIFTON AVE STE H
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1715
Practice Address - Country:US
Practice Address - Phone:973-310-9066
Practice Address - Fax:866-464-3951
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344045363LF0000X
NJ26NJ01103900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05509522Medicaid
NJ0818569Medicaid