Provider Demographics
NPI:1104164649
Name:MOSTOFF, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MOSTOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E. 64TH STREET SUITE 402
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:212-759-4553
Mailing Address - Fax:212-649-4601
Practice Address - Street 1:3830 PARK AVE
Practice Address - Street 2:SUITE #208
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-494-0895
Practice Address - Fax:732-494-0896
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01481800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist