Provider Demographics
NPI:1710276753
Name:MOURAD, MOUSTAFA W (MD)
Entity Type:Individual
Prefix:
First Name:MOUSTAFA
Middle Name:W
Last Name:MOURAD
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 1:923 5TH AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2681
Mailing Address - Country:US
Mailing Address - Phone:212-832-0444
Mailing Address - Fax:212-832-0009
Practice Address - Street 1:923 5TH AVE APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2681
Practice Address - Country:US
Practice Address - Phone:212-832-0444
Practice Address - Fax:212-832-0009
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266675207YX0007X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX357912001Medicaid