Individual
MRS. RANYA M MUSTAFA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3O PROSPECT AVE, HACKENSACK, NJ 07601-1902
(551) 996-3192
(551) 996-4239
Mailing address
192 EXECUTIVE DR, NEW HYDE PARK, NY 11040-1051
(516) 707-9991
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
019570
NY
363A00000X
Physician Assistant
Primary
25MP00398700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MP00398700
STATE LICENSE
NJ
Enumeration date
03/08/2016
Last updated
05/10/2020
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