Provider Demographics
NPI:1366624744
Name:JAFRI, MUMTAZ (MD)
Entity Type:Individual
Prefix:
First Name:MUMTAZ
Middle Name:
Last Name:JAFRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1366 VICTORY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3907
Mailing Address - Country:US
Mailing Address - Phone:718-442-8351
Mailing Address - Fax:718-442-4073
Practice Address - Street 1:1366 VICTORY BLVD STE B
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3907
Practice Address - Country:US
Practice Address - Phone:718-442-8351
Practice Address - Fax:718-442-4073
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY126904-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC66787Medicare UPIN