Provider Demographics
NPI:1568942605
Name:MUSTAFA, GHASSAN
Entity type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:
Last Name:MUSTAFA
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 1:450 CLARKSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2098
Mailing Address - Country:US
Mailing Address - Phone:718-270-1625
Mailing Address - Fax:718-270-1985
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2098
Practice Address - Country:US
Practice Address - Phone:718-270-1625
Practice Address - Fax:718-270-1985
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3343832080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine