Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 266675 | NY |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 266675 | NY |
NPI | 1710276753 |
---|---|
Provider Name | Moustafa W. Mourad |
First Address | New York, NY 10065-8185 |
Second Address | New York, NY 10065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2011 |
Last Update Date | 16/09/2021 |