Provider Demographics
NPI:1942808902
Name:MUSTAFA, YASMEN
Entity type:Individual
Prefix:
First Name:YASMEN
Middle Name:
Last Name:MUSTAFA
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 1:458 CLIFTON AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2675
Mailing Address - Country:US
Mailing Address - Phone:201-931-8581
Mailing Address - Fax:888-781-1193
Practice Address - Street 1:458 CLIFTON AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2675
Practice Address - Country:US
Practice Address - Phone:201-931-8581
Practice Address - Fax:888-781-1193
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor