Provider Demographics
NPI:1639765704
Name:MUJTABA NP IN FAMILY HEALTH, P.C.
Entity type:Organization
Organization Name:MUJTABA NP IN FAMILY HEALTH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ATHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MUJTABA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:917-982-5007
Mailing Address - Street 1:10426 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2328
Mailing Address - Country:US
Mailing Address - Phone:917-982-5007
Mailing Address - Fax:
Practice Address - Street 1:10426 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2328
Practice Address - Country:US
Practice Address - Phone:718-533-0991
Practice Address - Fax:833-969-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty