Provider Demographics
NPI:1255510186
Name:MUNVER, UTTAM L (MD)
Entity type:Individual
Prefix:DR
First Name:UTTAM
Middle Name:L
Last Name:MUNVER
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 1:26 W BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1401
Mailing Address - Country:US
Mailing Address - Phone:201-947-0913
Mailing Address - Fax:201-947-0913
Practice Address - Street 1:26 W BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-1401
Practice Address - Country:US
Practice Address - Phone:201-947-0913
Practice Address - Fax:201-947-0913
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112069207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00202488Medicaid
NY00202488Medicaid