Provider Demographics
NPI:1649391038
Name:MUTHUVAPPA, JAFER SADIQUE
Entity Type:Individual
Prefix:MR
First Name:JAFER
Middle Name:SADIQUE
Last Name:MUTHUVAPPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HURST AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1624
Mailing Address - Country:US
Mailing Address - Phone:518-435-0145
Mailing Address - Fax:
Practice Address - Street 1:99 HURST AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1624
Practice Address - Country:US
Practice Address - Phone:518-435-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist