Provider Demographics
NPI:1649916941
Name:ELMEZAYEN, MOUSTAFA SHEHATA
Entity type:Individual
Prefix:MR
First Name:MOUSTAFA
Middle Name:SHEHATA
Last Name:ELMEZAYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MOUSTAFA
Other - Middle Name:SHEHATA
Other - Last Name:ELMEZAYEN
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 KENSINGTON AVE APT 505
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-5001
Mailing Address - Country:US
Mailing Address - Phone:646-944-0785
Mailing Address - Fax:
Practice Address - Street 1:30 KENSINGTON AVENUE APT 505
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304
Practice Address - Country:US
Practice Address - Phone:646-944-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor