Provider Demographics
NPI:1356101380
Name:MUSHTAQ, ZAIN BIN
Entity type:Individual
Prefix:
First Name:ZAIN BIN
Middle Name:
Last Name:MUSHTAQ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4954 GREAT NORTHERN MALL
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3307
Mailing Address - Country:US
Mailing Address - Phone:929-535-1677
Mailing Address - Fax:
Practice Address - Street 1:4954 GREAT NORTHERN MALL
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3307
Practice Address - Country:US
Practice Address - Phone:440-252-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
OH30.0280091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical