Provider Demographics
NPI:1952136319
Name:MUKHTAR, AREEJ ERUM
Entity type:Individual
Prefix:
First Name:AREEJ
Middle Name:ERUM
Last Name:MUKHTAR
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 1:11514 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3119
Mailing Address - Country:US
Mailing Address - Phone:678-549-5179
Mailing Address - Fax:
Practice Address - Street 1:500 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1901
Practice Address - Country:US
Practice Address - Phone:516-279-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP130618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health