Provider Demographics
NPI:1801511472
Name:MUSTOFA, AFROJA BINTA (RD CDN)
Entity type:Individual
Prefix:MISS
First Name:AFROJA
Middle Name:BINTA
Last Name:MUSTOFA
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7362 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2940
Mailing Address - Country:US
Mailing Address - Phone:800-571-8276
Mailing Address - Fax:888-974-0289
Practice Address - Street 1:596 BROADWAY STE 302
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3396
Practice Address - Country:US
Practice Address - Phone:800-571-8276
Practice Address - Fax:888-974-0289
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011127133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011127OtherCDN REGISTRATION
IL86253301OtherREGISTERED DIETITIAN REGISTRATION