Provider Demographics
NPI:1487643516
Name:JAMAL, SUMAYAH (MD)
Entity Type:Individual
Prefix:
First Name:SUMAYAH
Middle Name:
Last Name:JAMAL
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 1:166 5TH AVE
Mailing Address - Street 2:2ND FL.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5909
Mailing Address - Country:US
Mailing Address - Phone:212-229-0333
Mailing Address - Fax:646-218-4133
Practice Address - Street 1:166 5TH AVE
Practice Address - Street 2:2ND FL.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5909
Practice Address - Country:US
Practice Address - Phone:212-229-0333
Practice Address - Fax:646-218-4133
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201210207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG71702Medicare UPIN
NY07U68ZXYQ1Medicare PIN