Provider Demographics
NPI:1457521890
Name:SAVERIMUTTU, JESSIE KUMUDINIDEVI (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:KUMUDINIDEVI
Last Name:SAVERIMUTTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:398 GOWER ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5333
Mailing Address - Country:US
Mailing Address - Phone:646-417-0747
Mailing Address - Fax:718-865-5134
Practice Address - Street 1:398 GOWER ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5333
Practice Address - Country:US
Practice Address - Phone:646-417-0747
Practice Address - Fax:718-865-5134
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246193207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
9235428OtherADENA
P4206731OtherOXFORD
3125050OtherUNITED HEALTHCARE
1750734OtherGHI
060QH1OtherBLUES CROSS BLUESHIELD
NY03179884Medicaid
ID PH 43101OtherELDER PLAN
000600057348OtherHEALTH PLUS
5190872OtherCIGNA
3125050OtherUNITED HEALTHCARE