Provider Demographics
NPI:1093736472
Name:MUMTAZ, ARIF (MD)
Entity Type:Individual
Prefix:
First Name:ARIF
Middle Name:
Last Name:MUMTAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 GRASSLANDS RD-NYMC
Mailing Address - Street 2:DEPT OF MEDICINE-MUNGER PAVILION
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-493-8370
Mailing Address - Fax:914-594-4434
Practice Address - Street 1:95 GRASSLANDS RD-NYMC
Practice Address - Street 2:DEPT OF MEDICINE-MUNGER PAVILION
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-8370
Practice Address - Fax:914-594-4434
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212817207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00000043369OtherGHI HMO
NY2270004OtherAETNA HMO
MA2817OtherATLANTIS
NY2597923OtherGHI PPO
NY318944OtherMVP
NY5C6025OtherHEALTHNET
NY01693425Medicaid
NY5522730OtherAETNA PPO
P1101967OtherOXFORD
16N411OtherBLUE SHIELD