Provider Demographics
NPI:1366737934
Name:RAMMAL, MUSTAPHA (DDS)
Entity type:Individual
Prefix:DR
First Name:MUSTAPHA
Middle Name:
Last Name:RAMMAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 W 165TH ST APT 41
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-8120
Mailing Address - Country:US
Mailing Address - Phone:646-748-3985
Mailing Address - Fax:
Practice Address - Street 1:420 W 23RD ST APT GF
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2155
Practice Address - Country:US
Practice Address - Phone:212-929-9200
Practice Address - Fax:646-381-9720
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0561141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03491274Medicaid