Provider Demographics
NPI:1245617828
Name:MUMTAZ, NADEEM CHOUDHRY (MD)
Entity type:Individual
Prefix:
First Name:NADEEM
Middle Name:CHOUDHRY
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 1:4950 STATE HIGHWAY 30
Mailing Address - Street 2:UPPER LEVEL
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7520
Mailing Address - Country:US
Mailing Address - Phone:518-841-3770
Mailing Address - Fax:
Practice Address - Street 1:4950 STATE HIGHWAY 30
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7520
Practice Address - Country:US
Practice Address - Phone:518-841-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-02
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142393207Q00000X
NY306622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine