Provider Demographics
NPI:1891714630
Name:MUMFORD, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MUMFORD
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 1:16 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3105
Mailing Address - Country:US
Mailing Address - Phone:212-206-5200
Mailing Address - Fax:212-206-5251
Practice Address - Street 1:30 BROAD ST FL 45
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2942
Practice Address - Country:US
Practice Address - Phone:212-530-0630
Practice Address - Fax:212-867-4353
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0142087311Medicaid
NY0142087311Medicaid
NYA400098575Medicare PIN