Provider Demographics
NPI:1942808902
Name:MUSTAFA, YASMEN
Entity Type:Individual
Prefix:
First Name:YASMEN
Middle Name:
Last Name:MUSTAFA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PASSAIC AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1155
Mailing Address - Country:US
Mailing Address - Phone:201-359-6537
Mailing Address - Fax:888-781-1193
Practice Address - Street 1:50 PASSAIC AVE APT 401
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-1155
Practice Address - Country:US
Practice Address - Phone:201-359-6537
Practice Address - Fax:888-781-1193
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor