Provider Demographics
NPI:1932333101
Name:MUSTAFA, ROSE (MD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:MUSTAFA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1505
Mailing Address - Country:US
Mailing Address - Phone:845-598-0159
Mailing Address - Fax:
Practice Address - Street 1:2 CAPITAL WAY STE 505
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534
Practice Address - Country:US
Practice Address - Phone:609-537-6700
Practice Address - Fax:609-537-6717
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10126400208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery