Provider Demographics
NPI:1932595923
Name:MUTASA, SIMUKAYI (MD)
Entity Type:Individual
Prefix:
First Name:SIMUKAYI
Middle Name:
Last Name:MUTASA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:622 WEST 168TH STREET
Mailing Address - Street 2:PB-1-301 NYPH:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-4928
Mailing Address - Fax:212-305-8177
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:PB-1-301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-4928
Practice Address - Fax:212-305-8177
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP100549342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology