Provider Demographics
NPI:1063486611
Name:KARIMI, MUMTAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MUMTAZ
Middle Name:
Last Name:KARIMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DUNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2528
Mailing Address - Country:US
Mailing Address - Phone:716-661-1447
Mailing Address - Fax:
Practice Address - Street 1:890 E SECOND STREET
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701
Practice Address - Country:US
Practice Address - Phone:716-661-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02047441Medicaid
NYP00635014OtherMEDICARE RAILROAD
NY02047441Medicaid
NYP00635014OtherMEDICARE RAILROAD
NYBB6339Medicare ID - Type Unspecified
J400187459Medicare PIN