Provider Demographics
NPI:1588339931
Name:MUSTAFA, NICOLE ELIZABETH
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:MUSTAFA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 TREETOP CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403-1007
Mailing Address - Country:US
Mailing Address - Phone:973-908-2530
Mailing Address - Fax:
Practice Address - Street 1:450 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8480
Practice Address - Country:US
Practice Address - Phone:973-706-7620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-09-27
Deactivation Date:2021-08-30
Deactivation Code:
Reactivation Date:2021-09-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist