Provider Demographics
NPI:1881907863
Name:MUSHTAQ, MARYAM
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:MUSHTAQ
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 1:15050 14TH RD
Mailing Address - Street 2:C/O ALL IN 1 SPOT
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2607
Mailing Address - Country:US
Mailing Address - Phone:718-767-0091
Mailing Address - Fax:718-767-0086
Practice Address - Street 1:15050 14TH RD
Practice Address - Street 2:C/O ALL IN 1 SPOT
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2607
Practice Address - Country:US
Practice Address - Phone:718-767-0091
Practice Address - Fax:718-767-0086
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist