Provider Demographics
NPI:1407317365
Name:MUSTAFA, ALAAELDIN (MD/DO)
Entity type:Individual
Prefix:DR
First Name:ALAAELDIN
Middle Name:
Last Name:MUSTAFA
Suffix:
Gender:M
Credentials:MD/DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-374-4440
Mailing Address - Fax:856-325-5734
Practice Address - Street 1:1105 LAUREL OAK RD STE 165
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4312
Practice Address - Country:US
Practice Address - Phone:856-374-4440
Practice Address - Fax:856-325-5734
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MB12372800207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1030701Medicaid